Detailed Mechanism Funding and Narrative

Years of mechanism: 2008 2009

Details for Mechanism ID: 3688
Country/Region: Nigeria
Year: 2009
Main Partner: Catholic Relief Services
Main Partner Program: NA
Organizational Type: FBO
Funding Agency: HHS/HRSA
Total Funding: $24,568,535

Funding for Biomedical Prevention: Prevention of Mother to Child Transmission (MTCT): $928,000

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

?Extension of local government coverage to Enugu State

?Extension of EID activities to all sites

The PMTCT services will be linked to HCT, adult and pediatric care and treatment, ARV drugs, OVC,

TB/HIV, laboratory services and SI.

ACTIVITY DESCRIPTION:

In COP08, CRS AIDSRelief (AR) supported PMTCT services in 30 Local Partner Treatment Facilities

(LPTF) and 2 PMTCT satellite sites (An additional one LPTF and 2 satellites were supported as part of the

local government coverage strategy in Anambra state). In COP 09 AR will increase the PMTCT sites it

supports to an additional 3 LPTF sites and 13 satellites providing PMTCT services in an effort to

decentralize services and increase coverage. This will make it a total of 51 sites providing PMTCT services

in 16 states (Abia, Adamawa, Anambra, Benue, Ebonyi, Edo, Enugu, FCT, Imo, Kaduna, Kano, Kogi,

Nasarawa, Ondo, Plateau and Taraba). AR, with other IPs, will complete the implementation of the

PEPFAR-Nigeria Local Government Area (LGA) coverage strategy in Anambra, ensuring the provision of

PMTCT services in at least one health facility in every LGA of the state. This is a critical step toward

universal access to PMTCT services. AR will work to extend the local government coverage strategy to

Enugu State. This will involve the support of the Enugu state SASCP to establish PMTCT committees.

Through its PMTCT services AR will provide testing, counseling and received results to 29,000 pregnant

women. Antiretroviral (ARV) prophylaxis will be provided to 740 women and an additional 246 clients will be

placed on HAART for their own disease for a total of 986 women receiving antiretrovirals (4% positivity rate

and 85% retention in care based on historical data at AR supported LPTFs). In setting and achieving

COP09 targets, consideration has been given to strengthening the quality of service delivery in order to

promote the best outcomes.

This activity will include, as a part of the standard package of care, routine provider initiated opt-out HIV

counseling and testing (HCT) in antenatal clinics (ANC) for all presenting women and in labor and delivery

wards (L&D) and the immediate post-delivery setting for women of unknown HIV status. Same day results

will be provided to clients. AR will use group health information, individual pre test and posttest strategies

and rapid testing based on the National testing algorithm. Partner testing and couple counseling will be

offered as part of PMTCT services to enhance disclosure. AR, through its community and faith-based

linkages, will utilize community and home based care services to promote partner testing. Clients will have

access to free laboratory services including CD4 counts and STI screening. Free medications including

those for OIs as needed and hematinics will also be provided. In addition to receiving PMTCT services,

children of HIV positive clients will be linked to OVC services and, for those who are HIV positive, to

pediatric care and treatment services.

Pregnant women requiring HAART will be placed on such during pregnancy and referred to HIV

comprehensive care centers after delivery. Referral coordinators will be identified in all AR-supported sites

and the communities, with their capacities built in collaboration with other IPs. Consideration may also be

given depending on LPTF acceptability to provide ART services within ANC clinics in order to increase

acceptability of initiating care and treatment.

For the anticipated number of women not requiring HAART for their own health, the current National

guidelines recommended short course two drug ARV option will be provided. This includes ZDV from 28

weeks with intrapartum single dose nevirapine (sdNVP) and a 7-day ZDV/3TC postpartum tail or ZDV/3TC

from 34-36 weeks with intrapartum sdNVP and a 7-day ZDV/3TC postpartum tail. Infant prophylaxis will

consist of single dose NVP and ZDV for 6 weeks. Single dose nevirapine will be given to all women at first

contact. AR will use its community linkages and mother-to-mother support groups to encourage HIV+

pregnant women to deliver in a health facility. For those HIV+ women who choose not to do so and deliver

at home, the same community volunteers will follow-up and identify them for needed postpartum services.

AR will explore the training and utilization of traditional birth attendants (TBAs) in addition to the mother-to-

mother support groups to reach HIV+ women who choose to deliver outside of the health facility. A focal

person at each LPTF will be responsible for tracing HIV+ mothers and their infants in the community and

linking them back to care. The HIV+ mothers and their infants will be linked postpartum to ART care and

support services which will utilize a family-centered care model.

AR, through its pediatric care and support program, will offer HIV early infant diagnosis (EID) in line with the

National Early Infant Diagnosis scale-up plan from 6 weeks of age using dried blood spots (DBS).

Implementation of the EID scale-up will be done under the guidance of the GON and in conjunction with

other IPs who will be conducting the laboratory testing. AR will collaborate with GoN as appropriate for

commodities and logistics support of the EID program. Exposed infants will be actively linked to pediatric

care and treatment, while their families will be referred to age-appropriate OVC services. In COP09, AR will

work to implement EID with a view to activating all AR LPTFs and their satellites. PMTCT focal persons at

all AR LPTFs will keep records of all exposed infants at enrollment soon after birth, informing HIV+ mothers

of the 6 weeks exact date for DBS collection. AR will encourage hub LPTFs to step down DBS collection at

affiliate PMTCT satellite sites and thus decentralize EID activities at these sites. AR will train members of

PMTCT support groups in HCT skills. AR will engage PMTCT support groups and the larger support group

(s) in tracking unbooked pregnant women and infants in the community, linking them to sites where they

can access HCT. AR will establish linkages with other non-AR providers, public and private, proximal to AR

LPTFs, with full-fledged ANC activities. This will encourage two-way referrals of HIV+ mothers and their

infants from these providers to AR LPTFs and thus benefit from EID/ART activities at AR sites. Throughout

these linkages there were be a strong focus on ensuring confidentiality at all levels.

HIV+ women will be counseled in the pre and postnatal periods regarding exclusive breastfeeding with early

cessation or exclusive breast milk substitute if AFASS criteria are met using the National Infant Feeding

Curriculum. AR will support couples counseling and family disclosure that will enhance adherence to infant

Activity Narrative: feeding choices. Full and accurate information will be provided on family planning and prevention services.

Women accessing family planning services will be offered/referred for HIV Counseling and Testing. Infants

of positive mothers will be linked to immunization services and well childcare. Cotrimoxazole prophylaxis will

be provided to infants from 6 weeks of age until definitive HIV status can be ascertained.

In COP09, AR will strengthen its program for Continuous Quality Improvement (CQI) in order to improve

and institutionalize quality interventions. Monitoring and evaluation of the AIDSRelief PMTCT program will

be consistent with the national plan for patient monitoring. Within each regional TA team AR will have a

PMTCT specialist assisted by a team of nurses and counselors to offer technical assistance to LPTFs and

take the lead on training and supervisory activities. AR PMTCT specialists will work in conjunction with

regional CQI specialists, program managers, clinical associates, and LPTF PMTCT coordinators as well as

counterparts from other IPs. AR regional PMTCT specialists will join the CQI-led team in conducting site

visits at least quarterly during which they will evaluate PMTCT clinical services, HCT done in the PMTCT

setting, the utilization of National PMM tools and guidelines/SOPs, proper medical record keeping, referral

coordination, and use of standard operating procedures in PMTCT. On-site TA with more frequent follow-up

monitoring visits will be provided to address weaknesses when identified during routine monitoring visits.

AR will provide training on PMTCT service delivery to 45 healthcare workers and retraining of an additional

45 staff according to the national curriculum. Trained staff will be required to step down trainings to other

Health Care Workers in their facilities and in nearby government health facilities as a human capacity

development activity. AR will collaborate with UNICEF-supported PMTCT sites and the CRS 7D programs

for community and home based PMTCT initiatives in its scale-up plans.

Sustainability lies at the heart of the AR program, and is based on durable therapeutic programs and health

systems strengthening. AR will focus on the transition of the management of care and treatment activities to

indigenous organizations by actively using its extensive linkages with faith based groups and other key

stakeholders to develop a transition plan that is appropriate to the Nigerian context. The plan will be

designed to ensure the continuous delivery of quality HIV care and treatment, and all activities will continue

to be implemented in close collaboration with the Government of Nigeria to ensure coordination, information

sharing and long term sustainability. For the transition to be successful, sustainable institutional capacity

must be present within the indigenous organizations and LPTFs they support; therefore, AR will strengthen

the selected indigenous organizations according to their assessed needs, while continuing to strengthen the

health systems of the LPTFs. This capacity strengthening will include human resource support and

management, financial management, infrastructure improvement, and strengthening of health management

information systems.

CONTRIBUTIONS TO OVERALL PROGRAM AREA:

This activity will provide counseling and testing services to 29,000 pregnant women, and provide ARV

prophylaxis to 740 clients. This will contribute to the PEPFAR and GON prevention goals. With 44

operational sites in 18 states, AR PMTCT program supports the rapid scale up of PMTCT services desired

by the FMOH.

LINKS TO OTHER ACTIVITIES:

The PMTCT services will be linked to HCT, adult and pediatric care and treatment, ARV drugs, OVC,

TB/HIV, laboratory services and SI. Pregnant women who present for HCT services will be provided with

information about the PMTCT program and referred accordingly. ARV treatment services for infants and

mothers will be provided through ART services. Basic pediatric care, including TB care, is provided for

infants and children through pediatric care and treatment. All HIV+ women will be registered for adult care

and treatment services.

AR PMTCT activities will focus on strengthening community and home-based care services to pregnant

women where appropriate and in collaboration with the CRS 7-Diocese program and other family-centered

care services provided by UNICEF, GON and the Catholic Secretariat of Nigeria. The AR senior PMTCT

specialist will offer technical assistance to 7-Diocese facilities. AR will collaborate with other IPs, particularly

IHV-ACTION, working at tertiary institutions for early infant diagnosis using DBS technology.

POPULATIONS BEING TARGETED:

This activity targets women of reproductive age and their partners, infants and PLWHAs. This activity also

targets training of health care providers, TBAs and mothers who will work as peer educators.

EMPHASIS AREAS:

This activity has an emphasis on training, supportive supervision, quality assurance/improvement and

commodity procurement. Emphasis is also placed on development of networks/linkages/referral systems. In

addition, integrating PMTCT with ANC and other family-centered services while ensuring linkages to

Maternal-Child-Health (MCH) and reproductive health services will ensure gender equity in access to

HIV/AIDS services.

New/Continuing Activity: Continuing Activity

Continuing Activity: 12994

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

12994 6485.08 HHS/Health Catholic Relief 6365 3688.08 HHS/HRSA $1,425,000

Resources Services Track 2.0 CRS

Services AIDSRelief

Administration

6683 6485.07 HHS/Health Catholic Relief 4162 3688.07 Track 2.0 $1,150,000

Resources Services

Services

Administration

6485 6485.06 HHS/Health Catholic Relief 3688 3688.06 Track 1.0 $222,000

Resources Services

Services

Administration

Emphasis Areas

Construction/Renovation

Gender

* Addressing male norms and behaviors

* Increasing gender equity in HIV/AIDS programs

Health-related Wraparound Programs

* Child Survival Activities

* Family Planning

* Malaria (PMI)

* Safe Motherhood

* TB

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $180,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $20,000

and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.01:

Funding for Sexual Prevention: Abstinence/Be Faithful (HVAB): $145,000

ACTIVITY UNCHANGED FROM FY2008

In COP08 AIDSRelief (AR) is providing support to 31 Local Partner Treatment Facilities (LPTFs) and 10

satellite sites. In COP09 Sexual Prevention services will be offered through 34 local partner treatment

facilities (LPTF), 19 satellite sites, and 1 community based program in 16 states including Abuia, Adamawa,

Anambra, Benue, Ebonyi, Edo, Enugu, FCT, Imo, Kaduna, Kano, Kogi, Nassarawa, Ondo, Plateau, and

Taraba. All HIV programs supported by AR promote abstinence until marriage, and mutual fidelity within

marriage. AR does not finance, promote or distribute condoms. In line with its HIV Policy, however, AR does

provide age-appropriate, complete and accurate information about condoms to its partners as part of its HIV

activities. AR will implement its AB programming activities in line with the overall PEPFAR Nigeria goal of

providing prevention services to individuals reached through a balanced portfolio of prevention activities.

Through the involvement of AR as a partner in this activity, PEPFAR Nigeria will extend its reach with AB

services in more states and communities. AR will provide full and accurate information on prevention

services. In COP 09, AR will dedicate a staff to focus on sexual prevention activities.

The program will support local partner treatment facility (LPTF) activities targeting HIV+ clients, their

families and communities who access care at these points of service. Prevention priorities will include

behavior change for risk reduction and risk avoidance and counseling and testing. All AR supported LPTFs

will provide education and training to patients and community health volunteers on secondary prevention.

This includes encouraging appropriate status disclosure according to OGAC and national guidelines,

counseling for sero-discordant couples, risk reduction and adherence to ART, and training for health

workers and peer outreach workers. Programs will include reducing societal stigma through appropriate

health education at facility and community levels and reducing gender based violence. There will be

structured peer education that includes systematic training curricula, refresher training, and training on

essential life skills. In addition, age appropriate abstinence only messaging and secondary abstinence

messaging will be conveyed to adolescents, especially orphans and vulnerable children receiving both

facility and home based support. AR through this program will cover the communities with AB messages

conveyed through multiple media. Through this methodology, a large number of people will be reached with

messages via one method or another; however, in line with the National Minimum Prevention Package

requirements, the counted group will be those individuals that would have received AB messaging: on a

regular basis and via the three strategies AR will employ (community awareness campaigns, peer education

models and peer education plus activities). AR anticipates reaching 6,591 people (2,636 male and 3,955

female) directly through community awareness campaigns, peer education models and peer education plus

activities; indirect beneficiaries are those who receive messages via other multiple media.

Data from the 2005 ANC Survey and the National HIV/AIDS and Reproductive Health Survey indicate a

high level of infection among 15 to 29 year olds together with a low level of risk perception (28%). AR will

incorporate messages that address behavior change, reduction of number of sexual partners, trans-

generational and transactional sex, sexually transmitted infections (STIs), and drug abuse into its services.

The strong community and adherence programs developed by LPTFs in the AR program will continue to

serve as the foundation for outreach to communities. In COP09, the program will continue to ensure that all

sites provide education to patients and community health volunteers on secondary prevention. Couple

centered prevention will also be emphasized. Prevention activities will include distribution of patient

education materials, community sensitization, increased couple testing, promotion of LPTF couple support

groups, and advocacy for risk reduction strategies for discordant relationships. High risk reduction

measures will include treatment of STIs and to a lesser extent interventions on drug abuse. Couples will be

treated at LPTFs or other referral centers that offer specialized treatment for STIs, where necessary.

AIDSRelief will provide full and accurate information on HIV prevention to all patients, as appropriate. AR

sites will integrate prevention with positives (PwP) activities including: adherence counseling; syndromic

management of STIs in line with National STI control policy and guidelines; risk assessment and behavioral

counseling to achieve risk reduction; counseling and testing of family members and sex partners;

counseling for discordant couples; IEC materials and provider delivered messages on disclosure. These

interventions will be implemented using the recently adapted HIV Prevention in Care and Treatment

Settings Prevention Package, which includes several training packages and job aids.

Fidelity in relationships will be promoted through information, education and communication (IEC) materials

and enlisting the support of religious leaders in community-led peer education plus activities, such as drama

groups. A family-centered approach will provide opportunities to maximize prevention messaging to all

family members. Linkages with CRS' OVC program will further promote messages that emphasize

abstinence and fidelity and the avoidance of high risk behaviors. AR will explore with its faith-based partners

opportunities for extending these messages into faith-based schools and developing peer educators in

schools. AR will draw on culturally appropriate prevention messaging material for these activities. AR will

enhance capacity development and partnership with the Federal government, State governments, Local

governments, CBO, and women's groups. Special messages targeting the males will be emphasized. AR

will implement its AB services while providing full and accurate information on other prevention services in

the area.

Training will be an integral part of this program and will be directed at facility staff, community level staff and

religious leaders. A total of 180 people (60 facility staff plus 120 community volunteers and religious

leaders) will be trained and given skills to be able to promote abstinence and being faithful messages to

patients, their families and communities.

Strategic information (SI) is crosscutting in all program areas. AIDSRelief SI activities will incorporate

program level reporting to enhance the effectiveness and efficiency of both paper-based and computerized

patient monitoring and management (PMM) systems, assure data quality and continuous quality

improvement, and promote data use for program decision making across all LPTFs. In COP09, AR will carry

out site visits to provide technical assistance that will ensure continued quality data collection, data entry,

data validation and analysis, and dissemination of findings across a range of stakeholders. It will provide

relevant, LPTF-specific technical assistance to develop specific data quality improvement plans. It will also

capture and report on individuals reached with abstinence and be faithful prevention messages using

Activity Narrative: relevant data collection tools and the PMM system.

Sustainability lies at the heart of the AR program, and is based on durable therapeutic programs and health

systems strengthening. AR will focus on the transition of the management of care and treatment activities to

indigenous organizations by actively using its extensive linkages with faith based groups and other key

stakeholders to develop a transition plan that is appropriate to the Nigerian context. The plan will be

designed to ensure the continuous delivery of quality HIV care and treatment, and all activities will continue

to be implemented in close collaboration with the Government of Nigeria to ensure coordination, information

sharing and long term sustainability. For the transition to be successful, sustainable institutional capacity

must be present within the indigenous organizations and LPTFs they support; therefore, AR will strengthen

the selected indigenous organizations according to their assessed needs, while continuing to strengthen the

health systems of the LPTFs. This capacity strengthening will include human resource support and

management, financial management, infrastructure improvement, and strengthening of health management

information systems.

CONTRIBUTIONS TO OVERALL PROGRAM AREA:

AR Sexual Prevention activities emphasize the integration of prevention activities with treatment and care

services. Use of community awareness campaigns, the peer educator model, and peer education plus

activities (community drama, dance events, etc.) allows dissemination of Sexual Prevention messaging.

This activity contributes to the USG target of preventing 1,145,545 new infections by 2009 through the

promotion of AB and A-only messaging in a comprehensive approach.

LINKS TO OTHER ACTIVITIES

Sexual prevention activities will be linked to HCT, basic care and support (through dissemination of

information by home based care providers and ultimately by decreasing demand on care services through

decreased prevalence), ARV services, ARV drugs, OVC, TB/HIV, laboratory services, and SI activities.

The program will also seek to link up with other CBOs/FBOs that serve the same geographic areas, as well

as partners working in other sectors, wherever possible to collaborate on meeting the needs of the

community. It also will seek to link the various cadres of government (Federal, State and Local government)

and seek effective collaboration with relevant NGOs.

POPULATIONS TARGETED:

Key populations targeted are the healthcare community in treatment facilities, PLWHA, youths and adults

accessing HCT services, support group members and family members of PLWHA.

KEY LEGISLATIVE ISSUES ADDRESSED

AB activities promote a rights based approach to prevention with positives and other vulnerable members of

society and equal access to information and services. The activities will also address issues of stigma and

discrimination through the education of individuals and communities reached.

EMPHASIS AREAS

This activity has an emphasis on training and community mobilization.

New/Continuing Activity: Continuing Activity

Continuing Activity: 15655

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

15655 15655.08 HHS/Health Catholic Relief 6365 3688.08 HHS/HRSA $200,000

Resources Services Track 2.0 CRS

Services AIDSRelief

Administration

Emphasis Areas

Gender

* Addressing male norms and behaviors

* Reducing violence and coercion

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $60,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.02:

Funding for Biomedical Prevention: Blood Safety (HMBL): $40,000

This activity will support the linkage of AIDSRelief (AR) supported Local Partner Treatment Facilities (LPTF)

and their satellite sites to the National Blood Transfusion Service (NBTS) zonal centers across the country.

In COP09, AR will be supporting 34 LPTFs and 19 satellite sites in 18 states (Abia, Adamawa, Anambra,

Benue, Delta, Ebonyi, Edo, Enugu, FCT, Imo, Kaduna, Kano, Kogi, Nasarawa, Ondo, Plateau, Rivers and

Taraba). Blood transfusions occur at all 34 LPTFs.

In COP09, AR will continue to work closely with the National Blood Transfusion Service (NBTS) and Safe

Blood for Africa Foundation (SBFA) in all aspects of its blood safety program. AR will support the NBTS in

implementing its primary objective of migrating fragmented hospital-based blood services to centralized

NBTS-based blood services nationwide. A key feature of this program is the development of a nationwide

voluntary donor recruitment system. NBTS, through linkages its zonal centers will develop with AR and its

supported facilities, will provide TA for blood donation drives held by these AR-supported hospital facilities.

In addition, SBFA will train nurses and medical laboratory scientists in these facilities to recruit repeat

voluntary blood donors from the ranks of current family replacement donors. In this plan, AR will be

instrumental in working with hospital management and staff at all LPTFs to develop buy-in for the NBTS

blood services program, to create support for blood donor organizers, and to strengthen health facility and

community focused blood drive activities. AIDSRelief will draw upon its unique position in working with

mainly faith-based facilities to facilitate blood donation activities within parishioner communities. AR will

support the distribution of IEC/BCC materials obtained from NBTS and SBFA to promote the need for

voluntary non-remunerated blood donation. In addition, AR will work closely with LPTF management to

establish blood transfusion committees to oversee blood use based on national algorithms and standards in

the health facilities.

Under this activity AR will continue the linkage of 5 AR-supported LPTF to proximal zonal NBTS centers in

Jos, Kaduna and Owerri. This linkage will include regular delivery of donated units of blood to NBTS for

screening in conjunction with a regular delivery of screened units of blood to the facility. NBTS will pick up

unscreened blood units that these 5 hospitals have appropriately collected and stored and will transport

these units back to NBTS centers where they will be screened for the 4 transfusion transmissible infections

(TTIs) of HIV I and II, hepatitis B, hepatitis C and syphilis using ELISA techniques. In addition to collecting

unscreened units, NBTS will deliver to these 5 hospitals their requested order of screened units for blood

banking and use at the facilities. NBTS will also provide monthly feedback on rates of the 4 TTIs found by

ELISA screening of blood units collected by each facility. It is expected that at these 5 blood banking

facilities a total of 1,125 transfusions will take place. AR will work to ensure that 80% of blood transfusions

that occur at these hospitals will be with NBTS-screened blood units, while only 20% will be emergency

transfusions whereby the hospital will screen the donors on site using rapid test kits only. Therefore, at least

900 units of blood will be collected and sent to the nearest NBTS centers for ELISA screening as outlined.

AR will work with the 34 LPTFs that do blood transfusions to ensure appropriate facility-level collection of

blood. Directed and voluntary donors will be prescreened with the NBTS donor screening questionnaire and

donors will be deferred as necessary based on their responses. Deferred donors will be offered HCT. At

least 450 blood donors will be screened using the National HCT testing algorithm, thereby utilizing the blood

donor setting as another point of service for HCT during pre-donation. A PEPFAR-supported evaluation of

the current emergency-based transfusion system will provide insight into rates of TTIs, including HIV, that

go undetected in emergency screened blood.

This activity will support personnel capacity development through SBFA-conducted blood safety training in

line with NBTS approved standardized training curricula appropriate to various levels of trainees. Through

this mechanism AR will identify 40 laboratory staff and other health care workers involved in blood

transfusion services at supported sites that will be trained by SBFA. In order to avoid double counting, these

40 targets are counted under the SBFA blood safety narrative. For core Training of Master Trainers (TOT)

modules developed by SBFA, AR will conduct step down training to 80 laboratorians, allied health workers

and hospital management staff involved in blood transfusion services at their sites.

In addition to institutional capacity building for blood safety activities, AR will support the implementation of

universal precautions, good laboratory practice, and waste management. This activity will promote the

principles of universal safety precautions and the reduction of occupational exposure to blood, and

accidental injury/contamination. Essential consumables and services that protect the health worker from

contacting infections, especially HIV, will be provided. These universal precaution materials include

personal protective equipment, such as hand gloves, laboratory coats, and other consumables (e.g.,

methylated-spirit, hypochlorite solutions, antibacterial soaps, etc.), which will be provided to sites. Other

equipment to be provided will include centrifuges, thermometers, pipettes, and HIV rapid test kits. In

addition, each site will establish clearly defined procedures for healthcare workers, other staff, and patients

to access post-exposure prophylaxis (PEP). Proper waste management will be encouraged through the use

of biohazard bags, suitable sharps containers and the use of incinerators. AR will also support clinical

meetings and seminars to promote rational use of blood and blood products and reduce unnecessary

transfusions.

In order to maintain high quality laboratory results, AR will continue its aggressive QA/QC program that

involves on-site quarterly monitoring, retraining, and proficiency in rapid HIV testing. Monitoring and

evaluation of the AIDSRelief blood safety program will be consistent with the NBTS national plan. There will

be evaluations of transfusion committee activities, infection control practices, waste management systems,

and use of standard operating procedures for donor screening and blood collection. On-site TA with more

frequent follow-up monitoring visits will be provided to address weaknesses when identified during routine

monitoring visits.

Sustainability lies at the heart of the AR program, and is based on durable therapeutic programs and health

systems strengthening. In COP09, AR will focus on the transition of the management of care and treatment

activities to indigenous organizations by actively using its extensive linkages with faith based groups and

other key stakeholders to develop a transition plan that is appropriate to the Nigerian context. The plan will

be designed to ensure the continuous linkage with the National Blood Transfusion Service for access to

Activity Narrative: safe blood, and that all activities facilitate effective coordination, information sharing and long term

sustainability. For the transition to be successful, sustainable institutional capacity must be present within

the indigenous organizations and LPTFs they support; therefore, AR will strengthen the selected

indigenous organizations according to their assessed needs, while continuing to strengthen the health

systems of the LPTFs. This capacity strengthening will include human resource support and management,

financial management, infrastructure improvement, and strengthening of health management information

systems.

CONTRIBUTION TO OVERALL PROGRAM AREA:

This activity contributes to USG and GON prevention efforts through the prevention of medical transmission

of HIV by ensuring a supply of safe and screened blood for blood transfusions. This activity will continue to

establish mechanisms for linkages with NBTS centers for blood banking services, while providing the

logistics and training to AR health facilities to effectively collect and store blood. Donor drives in the faith

based communities for VNRD will be done in collaboration with the NBTS. This also contributes to the

overall goal of GON to establish an effective and nationally coordinated and regulated blood program.

LINKS TO OTHER ACTIVITIES:

This activity is linked to HCT, PMTCT, care and treatment services, OVC, laboratory services, AB, injection

safety, and SI. AR activities in blood safety relate to HCT since HCT services will be made available to

deferred donors. Injection safety is linked thru universal precautions equipment and laboratory equipment.

This activity is most immediately linked to laboratory services to strengthen the collection, testing and

storage of blood units at LPTFs. Through transfusion committees and trainings AR will strengthen the links

with other LPTF health services to ensure that these activities benefit from a screened, safe blood supply

which will also promote program sustainability.

POPULATIONS BEING TARGETED:

This activity targets health care providers, particularly laboratory staff including laboratory assistants and

phlebotomists. This activity also targets doctors and nurses. AR mainly works with faith-based rural facilities

that serve rural populations who would otherwise have limited or no access to these services. Adults 18

years and above in these communities will be targeted as voluntary non-remunerated blood donors.

EMPHASIS AREAS

This activity has an emphasis on training and institutional capacity building

New/Continuing Activity: Continuing Activity

Continuing Activity: 12995

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

12995 5392.08 HHS/Health Catholic Relief 6365 3688.08 HHS/HRSA $115,000

Resources Services Track 2.0 CRS

Services AIDSRelief

Administration

6676 5392.07 HHS/Health Catholic Relief 4162 3688.07 Track 2.0 $0

Resources Services

Services

Administration

5392 5392.06 HHS/Health Catholic Relief 3688 3688.06 Track 1.0 $72,000

Resources Services

Services

Administration

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $3,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Program Budget Code: 05 - HMIN Biomedical Prevention: Injection Safety

Total Planned Funding for Program Budget Code: $2,938,502

Total Planned Funding for Program Budget Code: $0

Table 3.3.05:

Funding for Biomedical Prevention: Injection Safety (HMIN): $75,000

ACTIVITY DESCRIPTION

AIDSRelief (AR) local partner treatment facilities (LPTFs) consist largely of primary healthcare institutions

located within communities that are poor and underserved in all areas of social infrastructure including

healthcare. A proportion of HIV infections are still transmitted within these healthcare facilities through

unsafe injection practices. In COP08, AR supported specific safe injection activities at 31 LPTFs and 10

satellite clinics in the 16 states of Abia, Adamawa, Anambra, Benue, Ebonyi, Edo, Enugu, FCT, Imo,

Kaduna, Kano, Kogi, Nasarrawa, Ondo, Plateau and Taraba. In COP09, AR will expand to support safe

injection activities at a total of 53 sites (34 LPTF and 19 satellite sites) in a total of 18 states of Abia,

Adamawa, Anambra, Benue, Delta, Ebonyi, Edo, Enugu, FCT, Imo, Kaduna, Kano, Kogi, Nasarrawa, Ondo,

Plateau Rivers and Taraba. In setting and achieving COP09 targets, consideration has been given to

modulating AR's rapid COP07 scale-up plans in other programs in order to concomitantly work towards

continuous quality improvement.

AR injection safety activities encompass the training of infection control personnel from each supported

facility on universal precautions and medical waste management. Healthcare workers trained in

collaboration with John Snow Inc./Making Medical Injections Safer (JSI/MMIS) will step down the training to

ensure sustainability and behavioral change. It is expected that a total of 120 personnel will be trained. This

step down training to other LPTF staff, including nurses, doctors, laboratory staff, hospital cleaners, laundry

workers and waste managers, will include topics such as proper techniques for giving injections, drawing

blood, dispensing blood into laboratory bottles for laboratory testing, and disposal of used needles, sharps

and other materials contaminated by blood and other biohazardous materials. AR will obtain and use MMIS

supplied manuals to conduct follow-up on-site training at AR-supported LPTFs. Behavioral change

communication (BCC) activities will be carried out to reduce unnecessary use of injections. In COP09, AR

will work with MMIS to provide supportive supervision to all trained AR supported facilities.

AR will collaborate with JSI/MMIS to supply and distribute single-use needles, safety boxes, and personal

protective equipments to all AR-supported LPTFs. This activity will provide retractable needles and

syringes, sharps containers, and liquid hand washing soap in LPTF wards, clinic rooms, laboratory work

stations, and strategic areas to encourage their use. This activity will also provide personal protective

equipment (PPE) for health workers and ancillary hospital staff who come into contact with sharps and

contaminated materials. AR will work with each LPTF to improve access to water at each hand washing

point. For sustainability purposes, AR will ensure that these activities are integrated within each facility's

overall infection prevention and control and workplace safety programs. AR will also support post-HIV

exposure prophylaxis (PEP) programs at all sites.

Health care waste management will also be supported in this activity. Incinerators will be repaired and

fueled where they are available and constructed where there are no incinerators.

In COP09, AR will strengthen its program for Continuous Quality Improvement (CQI) to improve and

institutionalize quality interventions. CQI specialists and laboratorians will conduct team site visits at least

quarterly during which there will be evaluations of infection control practices, waste management

procedures, proper record keeping, and use of standard operating procedures for injection safety.

CONTRIBUTIONS TO OVERALL PROGRAM AREA

This activity contributes to the USG Nigeria target of preventing 1,145,545 new HIV infections through the

prevention of medical transmission of HIV. Planned institutional and human capacity building and the

provision of safe injection commodities/PPE will reduce occupational hazards and unnecessary exposure of

health workers and ancillary staff to blood borne pathogens.

LINKS TO OTHER ACTIVITIES

AIDSRelief activities in injection safety relate to activities in ARV services, PMTCT, laboratory services,

basic care and support, TB/HIV, OVC, blood safety, and SI to ensure that healthcare providers and ancillary

staff under all these programs adhere to the principles of infection prevention and control including injection

safety.

POPULATIONS BEING TARGETED

This activity will mainly target healthcare providers including doctors, laboratory workers, nurses,

pharmacists. Ancillary staff, who may not have direct patient contact but handle or manage biohazardous

materials, will also be targeted.

KEY LEGISLATIVE ISSUES ADDRESSED

Through the increased knowledge gained by healthcare workers and laypersons via IEC/BCC these

activities will result in a reduction in unsafe injection practices and unnecessary demand for injection. This

activity addresses issues of stigma and discrimination as the services will reduce stigma and discrimination

associated with HIV status in the health care facility setting and better care of PLWHA.

EMPHASIS AREAS

This activity has an emphasis on training on universal safety precautions, supportive supervision and

appropriate health care waste management.

New/Continuing Activity: Continuing Activity

Continuing Activity: 12996

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

12996 6820.08 HHS/Health Catholic Relief 6365 3688.08 HHS/HRSA $175,000

Resources Services Track 2.0 CRS

Services AIDSRelief

Administration

6820 6820.07 HHS/Health Catholic Relief 4162 3688.07 Track 2.0 $25,000

Resources Services

Services

Administration

Emphasis Areas

Workplace Programs

Human Capacity Development

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.05:

Funding for Care: Adult Care and Support (HBHC): $3,541,200

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS: Fusion of ART Services & Care and

support Services

In COP08 AIDSRelief (AR) is providing adult treatment, care and support services to 31 Local Partner

Treatment Facilities (LPTFs) and 10 satellite sites. In COP09 these services will be increased to cover an

additional 3 LPTFs and 9 satellites across the 16 states of Abia, Adamawa, Anambra, Benue, Ebonyi, Edo,

Enugu, FCT, Imo, Kaduna, Kano, Kogi, Nasarawa, Ondo, Plateau, and Taraba. Through primary and

secondary faith-based facilities AR in COP09 will continue to extend ART services to underserved rural

communities to reach 4,770 new patients for a total of 30,150 adult patients by the end of the year.

Comprehensive package of care and support services will be provided to a cumulative 50,589 PLWHA and

101,178 PABAs in the same period. In setting and achieving COP09 targets, consideration has been given

to consolidating on AR's rapid COP08 scale-up efforts in order to concomitantly work towards continuous

quality improvement.

The package of care services provided to each PLWHA includes a minimum of clinical service with basic

care kit and two supportive services in the domain of psychological, spiritual, and PwP delivered at the

facility, community, and household (home based care) levels in accordance with the PEPFAR and

Government of Nigeria (GON) national care and support policies and guidelines. The basic care package

for PLWHAs in AR's partner sites include Basic Care Kit (ORS, LLITN, water guard, water vessel, gloves,

ORS, soap and IEC materials,); Home-Based Care (client and caregiver training and education in self-care

and other HBC services); Clinical Care (basic nursing care, pain management, OI and STIs prophylaxis and

treatment, Laboratory Services (which will include baseline tests - CD4 counts, hematology, chemistry,

malarial parasite, OI and STI diagnostics when indicated) nutritional assessment- weight, height, BMI,

micronutrient counseling and supplementation and referrals; Psychological Care (adherence counseling,

bereavement counseling, depression assessment and counseling with referral to appropriate services);

Spiritual Care (access to spiritual care); Social Care (support groups' facilitation, referrals, and

transportation) and Prevention Care (Prevention with Positives). All PLWHAs' nutritional status will be

assessed at contact and on follow-up visits, micronutrients will be provided as necessary, and those

diagnosed as severely malnourished will be placed on a therapeutic feeding program. This will be done

through wraparound services as well as direct funding. AR will procure basic care kits through a central

mechanism and OI drugs will be procured mechanisms that ensure only NAFDAC approved drugs are

utilized.

ART sites at LPTFs that are co-located in facilities with TB DOTS centers will have the services integrated

to facilitate TB/HIV service linkages. All PLWHA will have CD4 counts and other necessary lab analyses

performed at least every 6 months to determine the optimal time and eligibility status to initiate ART and

monitor effectiveness/side effects for those on ART. AR sites will integrate prevention with positives (PwP)

activities including: adherence counseling; syndromic management of STIs in line with National STI control

policy and guidelines; risk assessment and behavioral counseling to achieve risk reduction; counseling and

testing of family members and sex partners; counseling for discordant couples; IEC materials and provider

delivered messages on disclosure. Cotrimoxazole prophylaxis will be provided for PLWHAs according to the

National guidelines. AR will support a pilot program for cervical cancer screening in HIV positive women.

AR will collaborate with faith-based organizations (FBOs) and community-based organizations (CBOs) such

as 7-Diocese of Catholic Relief Services (CRS) in Benue, Kaduna, Nasarawa and Edo states, CSADI in

Kano, Spring of Life in Plateau, New Life Support in Anambra and other CBOs attached to AR LPTFs in the

16 states. These FBOs and CBOs may be sub grantees of AR and/or other PEPFAR IPs. Through these

partnerships clients in care will receive a comprehensive package of community and home based care

services. LPTF HBC teams comprising nurses, community health workers and trained volunteers are

supported by AR to provide HBC services as well as facilitate support group activities. LPTFs HBC

providers will use HBC kits. AR will focus on improving pre-ART retention in support groups. Strategies to

retain clients in care include intensive home visits by HBC team during the first 6 months of enrolment.

All LPTFs will consolidate on their capacity to provide comprehensive quality ART services through existing

AR supported varieties of models of care delivery. This includes quality management of OIs and ART, a

safe, reliable and secure pharmaceutical supply chain, technologically appropriate lab diagnostics,

treatment preparation for patients, their families and supporters and community based support for

adherence. This technical and programmatic assistance utilizes on-site mentoring and preceptorship. It also

supports the development of site specific work plans and ensures that systems are in place for financial

accountability. AR will adhere to the Nigerian National ART service delivery guidelines including

recommended first and second line ART regimens. In addition, AR will partner with Clinton Foundation and

Global Fund as appropriate to leverage resources for providing antiretroviral drugs to patients.

In COP09 AR will continue to strengthen institutional and health worker capacity through the training,

retraining and mentoring of health service providers to provide care and treatment services at the facility

and community levels. Doctors, pharmacists, nurses, counselors, and community health extension workers

will receive training and onsite mentoring that will allow them to provide comprehensive care. Training will

maximize use of all available human resources including a focus on community nursing and community

adherence. Care and Treatment trainings will be based on the national curricula. AR will collaborate with the

GoN and other stakeholders to develop task shifting strategies to enable nurses and community health

officers to provide ART.

In COP09 AR will continue conducting 2-week intensive didactic and practical trainings preceding site

activation followed by regular onsite mentoring. AR will also train community volunteers including PLWHA

and religious leaders to provide peer education counseling, psychosocial and spiritual counseling,

respectively. AR will use GON/USG recommended standardized training curriculums, manuals and training

aides for all trainings. Information, education and communication materials will be provided to enhance

these trainings. AR will work closely with the USG and GoN team to monitor quality improvement at all sites

and across the program. 90 Health care workers will benefit from these trainings referred to above in HIV

Care, Treatment and Support.

Activity Narrative: A key component for successful ART is adherence to therapy at the household and community levels.

PLWHA on treatment are encouraged to have a treatment support person such as a family member to

whom he/she had disclosed HIV status to improve support in the home and increase adherence. AR will

continue to build and strengthen the community components by using nurses and counselors to link health

institutions to communities. Each LPTF will appoint a staff member to coordinate the linkages of patients to

all services. This will also build the capacity of LPTFs for better patient tracking, referral coordination, and

linkages to appropriate services. These activities will be monitored by the AR technical and program

management regional teams.

In COP09, AR will continue to strengthen its expanded Quality Improvement Program (QIP) consisting of

the annual cross sectional Outcomes & Evaluation (O&E) exercise, the GON/USG supported HIVQual

monitoring and the quarterly Continuous Quality Improvement (CQI) activities in order to improve and

institutionalize quality interventions. The 4 existing QIP specialists will be responsible for spearheading QIP

activities in their respective regions. This will include standardizing patient medical records to ensure proper

record keeping and continuity of care at all LPTFs. Monitoring and evaluation of the AIDSRelief ART

program will be consistent with the national plan for patient monitoring. The QIP specialists will conduct

team site visits at least quarterly during which there will be evaluations of infection control, the utilization of

National PMM tools and guidelines, proper medical record keeping, efficiency of clinic services, referral

coordination, and use of standard operating procedures across all disciplines. On-site technical assistance

(TA) with more frequent follow-up monitoring visits will be provided to address weaknesses when identified

during routine monitoring visits. Some of the data will be used to generate biannual life table analyses that

identify factors associated with early discontinuation of treatment. In addition, at each LPTF an annual cross

sectional evaluation of program quality shall consist of a 10% random sample of linked medical records,

adherence questionnaires and viral loads to examine treatment compliance and viral load suppression for

adult patients who have been on treatment for at least 9 months. A similar process will be undertaken for all

children who have been on ART for at least 9 months. Each of these activities will highlight opportunities for

improvement of clinical practices.

Sustainability lies at the heart of the AR program, and is based on durable therapeutic programs and health

systems strengthening. AR will focus on the transition of the management of care and treatment activities to

indigenous organizations by actively using its extensive linkages with faith based groups and other key

stakeholders to develop a transition plan that is appropriate to the Nigerian context. The plan will be

designed to ensure the continuous delivery of quality HIV care and treatment, and all activities will continue

to be implemented in close collaboration with the Government of Nigeria to ensure coordination, information

sharing and long term sustainability. For the transition to be successful, sustainable institutional capacity

must be present within the indigenous organizations and LPTFs they support; therefore, AR will strengthen

the selected indigenous organizations according to their assessed needs, while continuing to strengthen the

health systems of the LPTFs. This capacity strengthening will include human resource support and

management, financial management, infrastructure improvement, and strengthening of health management

information systems.

AR will continue to participate in Government of Nigeria (GON) harmonization activities and to participate in

the USG coordinated clinical working group to address ongoing topics in ARV service delivery.

CONTRIBUTIONS TO OVERALL PROGRAM AREA:

AR's expansion of adult care and treatment activities, including effective linkages with HBC providers, will

contribute to increased access of such services to underserved rural communities. By providing services to

50, 589 Adult PLWHA, AR will contribute to the overall PEPFAR care and support target of providing these

services to 10 million people globally by 2009 and will help accomplish the PEPFAR Nigeria target of

placing 350,000 clients on ART by 2009 and will also support the Nigerian government's universal access to

ART by 2010 initiative. This activity contributes to the overall AR comprehensive HIV and AIDS services by

providing the supportive services for all adult PLWHA including those on ART.

LINKS TO OTHER ACTIVITIES:

AR activities in adult care and treatment are linked to HCT, PMTCT, ARV drugs, laboratory, OVC, Sexual

Prevention, Medical Prevention, TB/HIV and SI to ensure that PLWHA and their family members have

access to a continuum of care. AR will continue to collaborate with the 7-D program of Catholic Relief

Services to establish networks of community volunteers to support livelihood development program for

PLWHA and caregivers requiring such services and support identified child or adolescent headed

households to be linked with CRS/SUN and other OVC programs which will meet the needs of the

household. Networks will be created to ensure cross-referrals and sharing of best practices among AR and

other implementing partner sites for the provision of psychosocial support and community and home based

services to PLWHA. Effective synergies will be established with the Global Fund to Fight AIDS,

Tuberculosis and Malaria through harmonization of activities with GON and other stakeholders for

harmonization of basic care and support services and the standardization of training manuals for community

volunteers and providers

POPULATIONS BEING TARGETED:

This activity targets PLWHA, particularly those who qualify for the provision of ART, including PMTCT

clients from rural and underserved communities. This activity also targets CBOs and FBOs for capacity

building and targets care providers (healthcare professionals and community volunteers) for training.

EMPHASIS AREAS:

This activity will include emphasis on human capacity development specifically through in-service training

and task-shifting, local organization capacity building for community mobilization and participation,

development of networks/linkages/referral systems, and quality assurance/ quality improvement This activity

will also ensure gender equity, ensuring access to ART through linkages with PMTCT services, addressing

male norms & behaviors, increasing women's legal rights and access to income & productive resources,

and reducing violence & coercion against women. AR will work with CBOs, networks of PLWHA and FBOs

Activity Narrative: and other USG/GON programs to promote economic strengthening activities; education and safe water

initiatives, and create access to food and nutritional services. The extension of this activity into rural and

previously underserved communities will contribute to the equitable availability of ART services in Nigeria

and towards the goal of universal access to ARV services in the country. This activity will improve the

quality of life of PLWHA and thus reduce the stigma and discrimination against them.

New/Continuing Activity: Continuing Activity

Continuing Activity: 12997

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

12997 5368.08 HHS/Health Catholic Relief 6365 3688.08 HHS/HRSA $2,797,655

Resources Services Track 2.0 CRS

Services AIDSRelief

Administration

6675 5368.07 HHS/Health Catholic Relief 4162 3688.07 Track 2.0 $1,630,000

Resources Services

Services

Administration

5368 5368.06 HHS/Health Catholic Relief 3688 3688.06 Track 1.0 $917,526

Resources Services

Services

Administration

Emphasis Areas

Gender

* Increasing gender equity in HIV/AIDS programs

Health-related Wraparound Programs

* Malaria (PMI)

* TB

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $90,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $25,000

and Service Delivery

Food and Nutrition: Commodities

Estimated amount of funding that is planned for Food and Nutrition: Commodities $25,000

Economic Strengthening

Education

Water

Estimated amount of funding that is planned for Water $25,000

Table 3.3.08:

Funding for Treatment: Adult Treatment (HTXS): $6,221,438

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

In COP09, CRS 7D will provide comprehensive BC&S to 20,000 People Living with HIV (PLHIV) and 60,000

People Affected by HIV/AIDS (PABAs) in 13 arch/dioceses (mega sites) in 8 states of Nigeria. CRS 7D will

continue to provide basic health care services in 5 saturated stand-alone and Primary Health Care (PHC)

facilities and client households across 251 parishes which are sub-sites from the mega sites totaling 65

PHC sites. Program growth in COP 09 will be focused in 5 saturation parishes in each of the 13 dioceses.

The total number of sites (parishes) will not increase in COP09 from COP08.

CRS 7D will continue to involve more PLHIV in the provision of palliative care services through recruitment

of HIV+ volunteers and support groups composed primarily of PLHIV.

Under social support, economic strengthening will be provided to PLHIV and PABAs through

individual/group grants and promotion of Savings and Internal Lending Community (SILC) - a CRS program

that works with groups to leverage internal savings as a mechanism for raising loan capital for group

members. The SG+ members will be expected to pay little intrest for the money they borrow which will

eventually form capital for the groups. This approach has been successfully implemented in South Sudan.

500 PAVs and SGP+ members will be trained to increase their capacity to provide care, support and

prevention in households, communities and PHC facilities.

Staff capacity enhancement will focus on PAV recruitment, motivation and retention. CRS 7D will explore

different mechanism of motivating volunteers in COP 09. These may include extension of economic

strengthening support through formation of SILC groups or through recognition of the best performing

volunteers by offering them awards.

COP 09 ACTIVITY DESCRIPTION:

In COP09, CRS 7D will provide comprehensive BC&S to 20,000 People Living with HIV (PLHIV) who were

already tested in the 135 CT service outlets according to FGoN Guidelines in 9 states (Kogi, Benue,

Plateau, Nassarawa, Niger, Kaduna, Edo, Cross River and Lagos states) including the FCT & registered by

sub-partners; and 60,000 People Affected by HIV/AIDS (PABAs) in 13 arch/dioceses. CRS 7D BC&S will

continue to provide basic health care services in 5 saturated stand-alone and Primary Health Care (PHC)

facilities and client households across 251 parishes which are sub-sites from the mega sites totaling 65

PHC sites. Program growth in COP 09 will be focused in 5 saturation parishes in each of the 13 dioceses.

CRS 7D will continue to involve State Ministry of Women Affairs (SMoWA), SMoH, SACA & LGA staff in

M&E visit to partners & training. The total number of sites (parishes) will not increase in COP09 from

COP08. The program will piggyback on activities of other program within 7D, SUN & AIDS Relief (AR) for

delivery of BC&S services to all those that require them. Clients will be linked to nutritional services as

identified including leveraging CHAI's resources.

CRS 7D will continue to support dioceses in developing institutional relationships with at least 5 PHC

facilities to provide basic clinical services to PLHIVs including: basic laboratory monitoring for OIs; urine &

stool analyses; STI & malaria treatment; basic OI prevention (CPT) & management. Management of OIs

will include treating basic OIs including malaria & syndromic management of STIs; LFT for PLHIV,

hemoglobin estimates, CD4 count & other advanced HIV disease laboratory diagnostic tests will be referred

to AIDSRelief (AR), & other USG IP supported sites, HIV+ pregnant women will be prioritized for CD4

testing & linked to HAART if needed. Clients will also receive PwP services at facilities and in the

communities.

For HBC services, CRS 7D will continue to support non-paid PAVs & Support Groups of People Living

Positively (SGP+) in the sites to provide non-clinical BC&S Services. In both cases, CRS 7D will continue to

involve more PLHIV in the provision of palliative care services through recruitment of HIV+ volunteers &

support groups composed primarily of PLHIV. CRS 7D will provide a basic preventive self care package

including, provision of ITN, water guard, water vessels, soap, ORS & basic first aid materials. Prevention for

positives will be incorporated into home visits & support group meetings through targeted messaging on

Abstinence & Be Faithful, counseling for discordant couples, & provision of complete & accurate

information/referrals for other prevention methods.

Under psychological care, 7D will provide psychosocial & spiritual counseling for PLHIV & PABAs, facilitate

SGP+ & adherence counseling. Counseling will address prevention, mental health, disclosure, crisis,

bereavement & adherence to all medication including ART, INH & CPT.

Under social support, economic strengthening will be provided to PLHIV & PABAs through individual/group

grants & promotion of Savings & Internal Lending Community (SILC) - a CRS program that works with

groups to leverage internal savings as a mechanism for raising loan capital for group members. Nutrition &

health education emphasizing personal hygiene & proper disposal of waste will continue to be provided.

Under spiritual care, 7D will be sensitive to the culture and rituals of the individuals & communities it

interacts with. With the 7D stigma & discrimination curriculum, 7D will train more clergy, traditional &

spiritual leaders on how to provide non-stigmatizing care.

7D will collaborate with the CRS SUN & AR programs in planning & providing holistic services to PLHIV &

families with infected individuals or OVCs. Mechanisms will be developed that allow the flow of human,

material & financial resources among the programs for effective leverage of each program's comparative

advantage. Coherently planning centrally and implementation in project sites will ensure seamless

integration for service beneficiaries.

AR & 7D ART & PMTCT sites will also provide palliative care for HIV+ pregnant women, PLHIV & OVC with

back & forth linkages among the 3 programs for ART, health, educational, social support & other services.

Through integrated activities among the three programs, PAVs and SGP+ will be given information that will

increase their capacity to provide care, support and prevention services in households, communities and

PHC facilities. 500 PAVs and SGP+ members will be trained using FGoN C&S providers' manual & CRS

HBC manual to increase their capacity to provide care, support and prevention in households, communities

Activity Narrative: & PHC facilities. Volunteers will continue to use HBC kits with the following contents 2 kidney dishes, a pair

of forceps & scissors, dressings, protective wears - disposable gloves, plastic aprons mackintosh, bleach

e.g. jik, washing materials e.g. plastic bowl, soap, towel soap container, lotions - calamine , ointment -

unscented petroleum jelly & waterguard bottles. Provision will be made to replenish the HBC kit contents

after each home visit. Each PHC facility is expected to reach 300 PLHIV with BC&S services. 7D will

engage SGP+ & PAVs in capacity building that will promote linkages between SGP+, PAVs & PHC facilities

for optimal utilization of health facilities & community resources. Service directories will be placed in

strategic places such as SGP+ meeting places & HCT centers.

In COP08 CRS carried out Training of Trainers (TOT) on food security and nutrition for Diocesan staff, who

will step down the training to the volunteers to increase their service provision to PLHIV. CRS through

collaboration with Clintons Foundation will leverage the supply of fortified nutritional supplements to PLHIV

as appropriate. CRS will continue to encourage food security & advocate to the dioceses to support food

supplementation to PLWHA, as this has been the practice for the past two years.

Staff capacity enhancement will focus on Partner Staff training, PAV recruitment, motivation & retention

FGoN Providers' manual and CRS HBC C&S manual. CRS 7D will explore different mechanisms of

motivating volunteers in COP 09. These may include extension of economic strengthening support through

formation of SILC groups or through recognition of the best performing volunteers by offering them awards.

For hard to reach areas, CRS 7D will carry out advocacy with diocesan authorities to facilitate PAVs with

motorbikes & fuel on days when they carry out home visits. Site hiring practices will be encouraged to draw

from experienced PAVs & SGP+. HBC Kits & other necessary tools will continue to be given to volunteers.

One PAV or SGP+ member will be assigned to a PHC center to triage with the PHC facilities & PLHIV &

SGP+ to facilitate access to clinical services. S/he will work with Diocesan Action Committee on AIDS

(DACA) staff to develop effective patient follow-up & referral mechanisms that bridge the health facility-

community gap. 7D will leverage 7D PMTCT & AR sites in the provision of advanced clinical services.

Organizational development support including administration & financial accounting will be given to PHC,

SGP+ & partners to position them for effective participation in BC&S service delivery. Transportation &

health care costs for caregivers & clients requiring specialized care not obtainable in immediate PHC will be

incorporated.

PAVs are trained to effectively collect data using stardardized M&E tools & are monitored by DACA staff

during home visits and as they fill the forms using the information generated. PLHIV are only counted as

direct beneficiaries when they access 1 clinical & at least 2 services from the other domains (psychological,

social, spiritual) then supplemental direct if they access only 1 service. Given the diversity of the package of

services PLHIV receive from different IPs, double counting of services will be highly probable. To avoid this,

7D in collaboration with other USG IPs will develop a tracking mechanism that follows the different services

from AR and other USG supported IPs.

CONTRIBUTIONS TO OVERALL PROGRAM AREA:

These BC&S services will contribute to several of the PEPFAR goals. The goal of mitigating the impact of

HIV/AIDS will be achieved by the provision of BC&S services. This activity will also contribute to the goal of

providing treatment to HIV+ individuals, as adults who are eligible for ART will be referred for these

services.

LINKS TO OTHER ACTIVITIES:

BC&S relates to other HIV/AIDS activities to ensure continuity of care for persons accessing BC&S through

the 7D. This activity links with Prevention of Mother to Child Transmission (PMTCT) (#5448.08), Voluntary

Counseling & Testing (#5422.08), Abstinence & Be Faithful (#5312.08) and OVC (5407.08) and SI activities

(#9913.08) being undertaken by CRS 7D. Given the increased integration of CRS programming, there will

also be close links to the activities across program areas being undertaken by CRS AIDSRelief especially

their ART activities (#6678.08).

POPULATIONS BEING TARGETED:

The populations to be served include children & youth, PLHIV & their families, caregivers &

widows/widowers within the 13 Arch/dioceses, LGA staff, clergy and lay people & health workers. Through

linkages with other program areas (PMTCT, VCT, ART), recently diagnosed HIV positive adults (including

TB-HIV) in these communities in need of BC&S are also targeted. Pediatric C&S clients will be assisted

through a family care approach and referred to the SUN program for additional child-centered services.

EMPHASIS AREAS:

The emphases of the BC&S Program activities are local organization capacity development, training,

developing networks, linkages & referral systems.

These activities will include an emphasis on reducing stigma associated with HIV status and the

discrimination faced by individuals with HIV/AIDS & their family members.

HIV prevention will include gender sensitive activities which will address behaviors, social norms & resulting

inequalities between men & women that increase the vulnerability to & impact of HIV/AIDS.

New/Continuing Activity: Continuing Activity

Continuing Activity: 13002

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

13002 6678.08 HHS/Health Catholic Relief 6365 3688.08 HHS/HRSA $7,102,211

Resources Services Track 2.0 CRS

Services AIDSRelief

Administration

Emphasis Areas

Construction/Renovation

Gender

* Increasing gender equity in HIV/AIDS programs

Health-related Wraparound Programs

* Malaria (PMI)

* TB

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $120,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Estimated amount of funding that is planned for Water $89,134

Table 3.3.09:

Funding for Care: Pediatric Care and Support (PDCS): $330,000

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

In COP08 AIDSRelief (AR) provided care and treatment services to 31 Local Partner Treatment Facilities

(LPTFs) and 10 satellite sites in 16 states of Abia, Adamawa, Anambra, Benue, Ebonyi, Edo, Enugu, FCT,

Imo, Kaduna, Kano, Kogi, Nasarawa, Ondo, Plateau, and Taraba. In COP09 these services will be

maintained and expanded to an additional 3 LPTFs and 9 satellite sites, for a total of 53 sites with further

emphasis on decentralization to community and home levels. Through primary and secondary faith-based

facilities, AR will extend care and treatment services to underserved rural communities to reach 3,350

children on ART (530 new) by the end of the COP year. In setting and achieving COP09 targets,

consideration has been given to modulating AR's rapid COP07 scale-up plans in order to concomitantly

work towards continuous quality improvement.

Key to increasing pediatric enrollment into care and treatment will be to strengthen linkages at all service

levels within the LPTFs where AR is working as well as reinforced and expanded community outreach. This

will require staff training and strengthened referral linkages. In order to increase the number of children

brought into care and treatment, AR will support a multi pronged approach: organization of services to

provide family centered care and treatment, provider initiated testing and counseling for children (PITC) and

community mobilization. Organization of ART clinics to include family days will also provide opportunities to

increase testing for children and provide comprehensive care. All exposed infants delivered in the LPTFs, or

identified through the family centered approach, will be linked to the HIV Comprehensive Care clinic for

enrollment for care and support, and to community-based OVC programs.

The package of care services provided to each HIV positive child/care givers includes a minimum of clinical

service with provision of a basic care kit and two supportive services in the domain of psychological,

spiritual, and PwP delivered at the facility, community, and household (home-based care, HBC) levels in

accordance with the PEPFAR and Government of Nigeria (GON) national care and support policies and

guidelines. The basic care package for HIV positive child/care givers in AR's partner sites includes provision

of a basic care kit (ORS, LLITN, water guard, water vessel, soap, IEC materials, and gloves); home-based

care (client and caregiver training and education in self-care and other HBC services); clinical care (basic

nursing care, pain management, OI and STIs prophylaxis and treatment, nutritional assessment- weight,

height, BMI, micronutrient counseling and supplementation and referrals); laboratory services (which will

include baseline tests - CD4 counts, hematology, chemistry, malarial parasites, OI and STI diagnostics

when indicated); psychological care (adherence counseling, bereavement counseling, depression

assessment and counseling with referral to appropriate services); spiritual care (access to spiritual care);

social care (support groups' facilitation, referrals, and transportation) and prevention care (Prevention with

Positives). All HIV positive children's nutritional status will be assessed at contact and on follow-up visits,

micronutrients will be provided as necessary, and those diagnosed as severely malnourished will be placed

on a therapeutic feeding program. This will be done through wraparound services as well as direct funding.

AR will procure basic care kits through a central mechanism and OI drugs will be procured through

mechanisms that ensure only NAFDAC approved drugs are utilized.

All LPTFs will be strengthened in their capacity to provide comprehensive quality care and treatment

services through a variety of models of care delivery. This includes quality management of OIs and ART, a

safe, reliable and secure pharmaceutical supply chain, technologically appropriate lab diagnostics,

treatment preparation for patients, their families and supporters and community based support for

adherence. This technical and programmatic assistance utilizes on-site mentoring and preceptorship. It also

supports the development of site specific work plans and ensures that systems are in place for financial

accountability.

AR will provide DBS/DNA PCR technology for early infant diagnosis (EID) in addition to the logistic support

for transportation of blood samples to designated laboratories in collaboration with Clinton Foundation. EID

activities supported under pediatric care and treatment are linked to PMTCT. AR will provide access to viral

loads for children with suspected treatment failure. All infected children will be evaluated for ART using CD4

count or CD4%. All AR sites will be equipped with capacity to determine CD4% for evaluation of

immunological status of children less than six years.

Based on available evidence concerning child survival and morbidities in relation to immunological staging,

AR will provide ARVs for all infected infants (less than 1 year) in accordance with revised national pediatric

ART guidelines so as to prevent mortality and brain damage in rapid progressors. Appropriate first and

second line regimens that preserve future options with minimal toxicity profiles will be adopted for all LPTFs.

AR will partner with Clinton Foundation and Global Fund as appropriate to leverage resources for providing

antiretroviral drugs to infected children.

ART sites at LPTFs are co-located in facilities with TB DOTS centers to facilitate TB/HIV service linkages.

AR will intensify collaboration with GON and other stakeholders to ensure prompt diagnosis of TB in

children and facilitate provision of pediatric TB formulations.

A key component for successful ART is adherence to therapy at the household and community levels. AR

will ensure intensive treatment preparation directed at an identified caregiver to ensure strict adherence. AR

will continue to build and strengthen the community components by using nurses and counselors to link

health institutions to communities. Each LPTF will appoint a specific staff member to coordinate the linkages

of patients to all services. This will also build the capacity of LPTFs for better patient tracking, referral

coordination, and linkages to appropriate services. These activities will be monitored by the AR technical

and program management regional teams. All children on ARVs will have at least monthly home visits to

ensure adherence and assess need for intervention. Specific efforts and training will be made to develop

adolescent friendly services for infected and affected children including linkages to reproductive health.

Non ART eligible children will be enrolled into care for periodic follow-up, including laboratory analysis at

least every six months, to identify changes in ART eligibility status. All enrolled children will be linked to the

AR OVC program to access an array of services including nutritional support, preventive care package

Activity Narrative: (water sanitation/treatment education, ITN) and psychosocial support. All LPTFs will be empowered with

training and tools to ensure nutritional assessment. Educational support and food supplements will be

leveraged from other partners, particularly the CRS SUN program and Catholic Secretariat of Nigeria USG

funded SUCCOUR program.

In COP08 AR trained 90 health service providers in pediatric care and treatment. In COP09 AR will train

and retrain an additional 90 health service providers according to the National Pediatric HIV Training

curriculum. Training will maximize use of all available human resources including a focus on community

nursing and community adherence to ensure care is decentralized to the home level. AR will collaborate

with the GON and other stakeholders to develop task shifting strategies to enable nurses and community

health officers to provide pediatric ART. AR will work closely with the USG team to monitor quality

improvement at all sites and across the program. AR will actively participate in and facilitate activities to

review practices in pediatric HIV care and treatment particularly GON technical working group meetings. AR

will share with the GON a new pediatric counseling curriculum developed with the African Network for

Caring for Children with HIV and, if acceptable, will roll this training out to all AR sites. AR will support the

development of a national pediatric HIV care and support guideline and training curriculum.

AIDSRelief will offer HIV EID in line with the National Early Infant Diagnosis scale-up plan from six weeks of

age using DBS. Implementation of the EID scale-up will be done under the guidance of the GON and in

conjunction with other IPs who will be conducting the laboratory testing. AR will collaborate with Clinton

Foundation as appropriate for commodities and logistics support for the EID program. Exposed infants will

be actively linked to pediatric care and treatment. In COP09, AR will extend EID activities/DBS collection to

all AR LPTFs and their satellites. PMTCT focal persons at all AR LPTFs will keep records of all exposed

infants at enrollment soon after birth; informing HIV+ mothers of the six week mark for DBS collection. AR

will encourage hub LPTFs to step down DBS collection at affiliate PMTCT satellite sites and thus

decentralize EID activities at these sites. Hub LPTFs will ensure supplies of DBS collecting kits from their

own stock to these satellites and the samples collected returned to the hub sites for dispatch to the testing

labs. AR will train members of PMTCT support groups in HCT skills. AR will engage PMTCT support groups

and the larger support group(s) in tracking unbooked pregnant women and infants in the community, linking

them to sites where they can access HCT. AR will establish linkages with other health care providers, public

and private, proximal to AR LPTFs, with full-fledged ANC activities. This will encourage two-way referrals of

HIV+ mothers and their infants from these providers to AR LPTFs and thus benefit from EID/ART activities

at AR sites. LPTF EID focal persons will ensure prompt dissemination of results to providers and mothers

as soon as they are available.

In COP08 AR built a team of four specialists to ensure Continuous Quality Improvement (CQI) to improve

and institutionalize quality interventions. The team will sustain the efforts with a modification of evaluation

tools to assess and report on both qualitative and quantitative indicators of care delivery. Monitoring and

evaluation of the AIDSRelief ART program will be consistent with the national plan for patient monitoring.

The CQI specialists will conduct team site visits at least quarterly during which there will be evaluations of

infection control, the utilization of National PMM tools and guidelines, proper medical record keeping,

efficiency of clinic services, referral coordination, and use of standard operating procedures. On-site TA with

more frequent follow-up monitoring visits will be provided to address weaknesses when identified during

routine monitoring visits. Some of the data will be used to generate biannual life table analyses that identify

factors associated with early discontinuation of treatment. In addition, at each LPTF an annual evaluation of

program quality shall consist of a 10% random sample of linked medical records, adherence questionnaires

and viral loads to examine treatment compliance and viral load suppression for children who have been on

treatment for at least nine months. Each of these activities will highlight opportunities for improvement of

clinical practices.

AR will focus on the transition of the management of care and treatment activities to indigenous

organizations by actively using its extensive linkages with faith-based groups and other key stakeholders to

develop a transition plan that is appropriate to the Nigerian context. The plan will be designed to ensure the

continuous delivery of quality HIV care and treatment, and all activities will continue to be implemented in

close collaboration with the Government of Nigeria to ensure coordination, information sharing and long

term sustainability. For the transition to be successful, sustainable institutional capacity must be present

within the indigenous organizations and LPTFs they support. As a result, AR will strengthen the selected

indigenous organizations according to their assessed needs, while continuing to strengthen the health

systems of the LPTFs. This capacity strengthening will include human resource support and management,

financial management, infrastructure improvement, and strengthening of health management information

systems.

AR will continue to participate in Government of Nigeria (GON) harmonization activities and to participate in

the USG coordinated clinical working group to address ongoing topics in ARV service delivery.

CONTRIBUTION TO THE OVERALL PROGRAM AREA:

By adhering to the Nigerian National ART service delivery guidelines and building strong community

components into the program, this activity will contribute to achieving global PEPFAR treatment targets and

will also support the Nigerian government's universal access to ART by 2010 initiative. By putting in place

structures to strengthen LPTF health systems, AR will contribute to the long term sustainability of the ART

programs.

AR will collaborate with the Catholic Relief Services 7D program to establish networks of community

volunteers. Networks will be created to ensure cross-referrals and sharing of best practices among AR and

other implementing partner sites. Effective synergies will be established with the Global Fund to Fight AIDS,

Tuberculosis and Malaria through harmonization of activities with GON and other stakeholders.

POPULATIONS BEING TARGETED:

This activity targets HIV exposed and infected children and their caregivers as well as HCWs from rural and

underserved communities.

Activity Narrative: LINKS TO OTHER ACTIVITIES:

This activity is linked to HCT services to ensure that people tested for HIV are linked to ART services; it also

relates to activities in ARV drugs, laboratory services, sexual prevention, PMTCT, OVC, TB/HIV, and SI.

EMPHASIS AREAS:

This activity will include emphasis on human capacity development specifically through in-service training.

These ART services will also ensure gender and age equity in access to ART through linkages with OVC

and PMTCT services in AR sites and neighboring sites. The extension of ARV services into rural and

previously underserved communities will contribute to the equitable availability of ART services in Nigeria

and towards the goal of universal access to ARV services in the country. The provision of ART services will

improve the quality of life of infected children and thus reduce the stigma and discrimination against them.

New/Continuing Activity: Continuing Activity

Continuing Activity: 12999

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

12999 5416.08 HHS/Health Catholic Relief 6365 3688.08 HHS/HRSA $945,000

Resources Services Track 2.0 CRS

Services AIDSRelief

Administration

6679 5416.07 HHS/Health Catholic Relief 4162 3688.07 Track 2.0 $288,000

Resources Services

Services

Administration

5416 5416.06 HHS/Health Catholic Relief 3688 3688.06 Track 1.0 $150,625

Resources Services

Services

Administration

Emphasis Areas

Health-related Wraparound Programs

* Child Survival Activities

* Malaria (PMI)

* TB

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $60,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $20,000

and Service Delivery

Food and Nutrition: Commodities

Estimated amount of funding that is planned for Food and Nutrition: Commodities $10,000

Economic Strengthening

Education

Water

Table 3.3.10:

Funding for Treatment: Pediatric Treatment (PDTX): $938,000

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

In COP08 AIDSRelief (AR)provided Care and Treatment services to 31 Local Partner Treatment Facilities

(LPTFs) and 10 satellite sites in 16 states of Abia, Adamawa, Anambra, Benue, Ebonyi, Edo, Enugu, FCT,

Imo, Kaduna, Kano, Kogi, Nasarawa, Ondo, Plateau, and Taraba. In COP09 these services will be

maintained and expanded to an additional 3 LPTFs and 9 satellite sites, with further emphasis on

decentralization to community and home levels. Through primary and secondary faith-based facilities AR

will extend care and treatment services to underserved rural communities to reach 3,350 children on ART

(530 new) by the end of the COP year. In setting and achieving COP09 targets, consideration has been

given to modulating AR's rapid COP07 scale-up plans in order to concomitantly work towards continuous

quality improvement.

Key to increasing pediatric enrollment into care and treatment will be to strengthen linkages at all service

levels within the LPTFs that AR is working as well as reinforced and expanded community outreach. This

will require staff training and strengthened referral linkages. In order to increase the number of children

brought into care and treatment, AR will support a multi pronged approach: organization of services to

provide family centered care and treatment, PITC (provider initiated testing and counseling for all children)

and community mobilization. Organization of ART clinics to include family days will also provide

opportunities to increase testing for children and provide comprehensive care. All exposed infants delivered

in the LPTF or identified through the family centered approach will be linked to the HIV Comprehensive

Care clinic for enrollment for care and support, and to community based OVC programs.

The package of care services provided to each HIV positive child/care givers includes a minimum of clinical

service with basic care kit and two supportive services in the domain of psychological, spiritual, and PwP

delivered at the facility, community, and household (home based care) levels in accordance with the

PEPFAR and Government of Nigeria (GON) national care and support policies and guidelines. The basic

care package for HIV positive child/care givers in AR's partner sites include Basic Care Kit (ORS, LLITN,

water guard, water vessel, soap, IEC materials, and gloves); Home-Based Care (client and caregiver

training and education in self-care and other HBC services); Clinical Care (basic nursing care, pain

management, OI and STIs prophylaxis and treatment, nutritional assessment- weight, height, BMI,

micronutrient counseling and supplementation and referrals, Laboratory Services (which will include

baseline tests - CD4 counts, hematology, chemistry, malarial parasite, OI and STI diagnostics when

indicated); Psychological Care (adherence counseling, bereavement counseling, depression assessment

and counseling with referral to appropriate services); Spiritual Care (access to spiritual care); Social Care

(support groups' facilitation, referrals, and transportation) and Prevention Care (Prevention with Positives).

All HIV positive children's nutritional status will be assessed at contact and on follow-up visits,

micronutrients will be provided as necessary, and those diagnosed as severely malnourished will be placed

on a therapeutic feeding program. This will be done through wraparound services as well as direct funding.

AR will procure basic care kits through a central mechanism and OI drugs will be procured mechanisms that

ensure only NAFDAC approved drugs are utilized.

All LPTFs will be strengthened in their capacity to provide comprehensive quality care and treatment

services through a variety of models of care delivery. This includes quality management of OIs and ART, a

safe, reliable and secure pharmaceutical supply chain, technologically appropriate lab diagnostics,

treatment preparation for patients, their families and supporters and community based support for

adherence. This technical and programmatic assistance utilizes on-site mentoring and preceptorship. It also

supports the development of site specific work plans and ensures that systems are in place for financial

accountability.

AR will provide DBS/DNA PCR technology for early infant diagnosis in addition to the logistic support for

transportation of blood samples to designated laboratories in collaboration with Clinton foundation. AR

Regional laboratories will be provided with capacity to do viral load and AR will provide access to viral loads

for children with suspected treatment failure. All infected children will be evaluated for ART using CD4 or

CD4%. All AR sites will be equipped with capacity to determine CD4% for evaluation of immunological

status of children less than 6 years.

Based on available evidence on child survival and morbidities in relation to immunological staging, AR will

provide ARVs for all infected infants (less than 1 year) tin accordance with revised National pediatric ART

guidelines so as to prevent mortality and brain damage in rapid progressors. Appropriate first and second

line regimens that preserve future options with minimal toxicity profiles will be adopted for all LPTF. AR will

partner with Clinton Foundation and Global Fund as appropriate to leverage resources for providing

antiretroviral drugs to infected children.

ART sites at LPTFs are co-located in facilities with TB DOTS centers to facilitate TB/HIV service linkages.

AR will intensify collaboration with GON and other stakeholders to ensure prompt diagnosis of TB in

children and facilitate provision of pediatric TB formulations.

A key component for successful ART is adherence to therapy at the household and community levels. AR

will ensure intensive treatment preparation directed at an identified caregiver to ensure strict adherence

AR will continue to build and strengthen the community components by using nurses and counselors to link

health institutions to communities. Each LPTF will appoint a specific staff member to coordinate the linkages

of patients to all services. This will also build the capacity of LPTFs for better patient tracking, referral

coordination, and linkages to appropriate services. These activities will be monitored by the AR technical

and program management regional teams. All children on ARV will have at least monthly home visits to

ensure adherence and assess need for intervention. Specific efforts and training will be made to develop

adolescent friendly services for infected and affected children including linkages to reproductive health.

Non ART eligible children will be enrolled into care for periodic follow-up, including laboratory analysis at

least every 6 months, to identify changes in ART eligibility status. All enrolled children will be linked to the

AR OVC program to access an array of services including nutritional support, preventive care package

(water sanitation/treatment education, ITN) and psychosocial support. All LPTFs will be empowered with

Activity Narrative: training and tools to ensure nutritional assessment. Educational support and food supplements will be

leveraged from other partners particularly the CRS SUN program and Catholic Secretariat of Nigeria USG

funded SUCCOUR program.

In COP08 AR trained 90 health service providers in pediatric care and treatment. In COP09 AR will train

and retrain an additional 90 health service providers according to the National Pediatric HIV Training

curriculum. Training will maximize use of all available human resources including a focus on community

nursing and community adherence to ensure care is decentralized to the home level. AR will collaborate

with the GoN and other stakeholders to develop task shifting strategies to enable nurses and community

health officers to provide Pediatric ART. AR will work closely with the USG team to monitor quality

improvement at all sites and across the program. AR will actively participate in and facilitate activities to

review practices in Pediatric HIV care and treatment particularly GON technical working group meetings. AR

will share with the GON a new pediatric counseling curriculum developed with the African Network for

Caring for Children with HIV and roll this training out to all AR sites. AR will support the development of a

national pediatric HIV care and support guideline, and training curriculum.

AIDSRelief will offer HIV early infant diagnosis (EID) in line with the National Early Infant Diagnosis scale-up

plan from 6 weeks of age using DBS. Implementation of the EID scale-up will be done under the guidance

of the GON and in conjunction with other IPs who will be conducting the laboratory testing. AR will

collaborate with Clinton Foundation as appropriate for commodities and logistics support for the EID

program. Exposed infants will be actively linked to pediatric care and treatment. In COP09, AR will extend

EID activities/DBS collection to all AR LPTFs and their satellites. PMTCT focal persons at all AR LPTFs will

keep records of all exposed infants at enrollment soon after birth; informing HIV+ mothers of the 6 weeks

exact dates for DBS collection. AR will encourage parent LPTFs to step down DBS collection at affiliate

PMTCT satellite sites and thus decentralize EID activities at these sites. Parent LPTFs will ensure supplies

of DBS collecting kits from their own stock to these satellites and the samples collected returned to the

parent sites for dispatch to the testing labs. AR will train members of PMTCT support groups in HCT skills.

AR will engage PMTCT support groups and the larger support group(s) in tracking unbooked pregnant

women and infants in the community, linking them to sites where they can access HCT. AR will establish

linkages with other health care providers; public and private, proximal to AR LPTFs, with full fledged ANC

activities. This will encourage two-way referrals of HIV+ mothers and their infants from these providers to

AR LPTFs and thus benefit from EID/ART activities at AR sites. LPTF EID focal persons will ensure prompt

dissemination of results to providers and mothers as soon as they are available.

In COP08 AR built a team of 4 specialists to ensure Continuous Quality Improvement (CQI) to improve and

institutionalize quality interventions. The team will sustain the efforts with a modification of evaluation tools

to assess and report on both qualitative and quantitative indicators of care delivery. Monitoring and

evaluation of the AIDSRelief ART program will be consistent with the national plan for patient monitoring.

The CQI specialists will conduct team site visits at least quarterly during which there will be evaluations of

infection control, the utilization of National PMM tools and guidelines, proper medical record keeping,

efficiency of clinic services, referral coordination, and use of standard operating procedures across all

disciplines. On-site TA with more frequent follow-up monitoring visits will be provided to address

weaknesses when identified during routine monitoring visits. Some of the data will be used to generate

biannual life table analyses that identify factors associated with early discontinuation of treatment. In

addition, at each LPTF an annual evaluation of program quality shall consist of a 10% random sample of

linked medical records, adherence questionnaires and viral loads to examine treatment compliance and

viral load suppression for adult patients who have been on treatment for at least 9 months. A similar

process will be undertaken for all children who have been on ART for at least 9 months. Each of the se

activities will highlight opportunities for improvement of clinical practices.

AR will focus on the transition of the management of care and treatment activities to indigenous

organizations by actively using its extensive linkages with faith based groups and other key stakeholders to

develop a transition plan that is appropriate to the Nigerian context. For the transition to be successful,

sustainable institutional capacity must be present within the indigenous organizations and LPTFs they

support; therefore, AR will strengthen the selected indigenous organizations according to their assessed

needs, while continuing to strengthen the health systems of the LPTFs. This capacity strengthening will

include human resource support and management, financial management, infrastructure improvement, and

strengthening of health management information systems.

AR will continue to participate in Government of Nigeria (GON) harmonization activities and to participate in

the USG coordinated clinical working group to address ongoing topics in ARV service delivery.

CONTRIBUTION TO THE OVERALL PROGRAM AREA:

By adhering to the Nigerian National ART service delivery guidelines and building strong community

components into the program, this activity will contribute to achieving the overall PEPFAR Nigeria target of

placing 35,000 children on ART by 2009 and will also support the Nigerian government's universal access

to ART by 2010 initiative. By putting in place structures to strengthen LPTF health systems, AR will

contribute to the long term sustainability of the ART programs.

LINKS TO OTHER ACTIVITIES:

This activity is linked to HCT services (5425.08) to ensure that people tested for HIV are linked to ART

services; it also relates to activities in ARV drugs (9889.08), laboratory services (6680.08), and care &

support activities including Sexual Prevention (5368.08), PMTCT (6485.08), OVC (5416.08), AB (15655.08),

TB/HIV (5399.08), and SI (5359.08).

AR will collaborate with the 7-D program of Catholic Relief Services to establish networks of community

volunteers. Networks will be created to ensure cross-referrals and sharing of best practices among AR and

other implementing partner sites. Effective synergies will be established with the Global Fund to Fight AIDS,

Tuberculosis and Malaria through harmonization of activities with GON and other stakeholders.

Activity Narrative: POPULATIONS BEING TARGETED:

This activity targets children infected with HIV and their caregivers/HCWs from rural and underserved

communities.

EMPHASIS AREAS:

This activity will include emphasis on human capacity development specifically through in-service training.

These ART services will also ensure gender and age equity in access to ART through linkages with OVC

and PMTCT services in AR sites and neighboring sites. The extension of ARV services into rural and

previously underserved communities will contribute to the equitable availability of ART services in Nigeria

and towards the goal of universal access to ARV services in the country. The provision of ART services will

improve the quality of life of infected children and thus reduce the stigma and discrimination against them.

New/Continuing Activity: Continuing Activity

Continuing Activity: 13002

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

13002 6678.08 HHS/Health Catholic Relief 6365 3688.08 HHS/HRSA $7,102,211

Resources Services Track 2.0 CRS

Services AIDSRelief

Administration

Emphasis Areas

Health-related Wraparound Programs

* Child Survival Activities

* Malaria (PMI)

* TB

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $60,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $20,000

and Service Delivery

Food and Nutrition: Commodities

Estimated amount of funding that is planned for Food and Nutrition: Commodities $10,000

Economic Strengthening

Education

Water

Table 3.3.11:

Funding for Care: TB/HIV (HVTB): $450,000

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

AIDS Relief's (AR) strategy for TB/HIV is to ensure that all HIV positive clients in Local Partners Treatment

Facilities (LPTFs) are routinely screened for TB while TB patients have access to HIV counseling and

testing (HCT). Dually infected clients are offered appropriate care within and outside the LPTF. In COP08,

AR is supporting TB DOTS centers at 31 LPTFs and HCT at 31 stand alone TB DOTS centers in 16 states

(Adamawa, Anambra, Benue, Ebonyi, Edo, Enugu, FCT, Kaduna, Kano, Kogi, Nasarrawa, Ondo, Plateau,

Taraba Abia and Imo). In COP09, AR will continue these services and expand services to 3 LPTFs and 12

satellites in the same states. In setting and achieving COP09 targets, consideration has been given to

modulating AR's rapid COP08 scale up plans in order to concomitantly work towards quality improvement

program and decentralizing services.

AR will continue to implement HCT in existing TB DOTS centers to provide HCT to all TB patients and

suspects and will also ensure facility co-location of TB DOTS centers in all supported LPTFs. Ten of the

current TB DOT Centers will have expanded satellite services to care and follow up patients on treatment.

Referral mechanisms will ensure TB/HIV co-infected clients access AIDSRelief (or other) supported HIV

care and treatment services. AR, with other IPs, will continue to implement the PEPFAR-Nigeria LGA

coverage strategy in Anambra, ensuring the provision of TB/HIV services in the existing identified AR

supported health facilities at the local government area (LGA). This is a critical step towards the provision of

universal access for TB/HIV services.

AR will implement the global 3 "I"s program of TB/HIV management strategy. In total, 20,000 HIV positive

patients in care at all AR supported sites will be rescreened for signs of TB clinically with symptom driven

follow up laboratory screening. From these 5%, or 1,000, are expected to be diagnosed with active disease

and will be treated for TB while 1%, or 200, without active TB will be place on Isonizide Preventive Therapy

(IPT) as a pilot program. The TB/HIV program will be in collaboration with State and National Tuberculosis

and Leprosy control programs (STBLCP and NTBLCP). A total of 1500 clients offered HIV counseling and

testing services from the TB DOTS centers will receive their results; it is expected that 10%, or 150, will be

diagnosed with HIV. Laboratory infrastructure will be upgraded and human capacity developed to ensure

adequate TB diagnosis for HIV positive patients. AR will continue to strengthen the pharmacy services at

supported TB DOTS sites to improve forecasting and avoid stock outs. AR will work with sites and State

Government to recognize and eliminate stock outs due to facility level or government level TB logistic

weaknesses, as an aspect of health systems capacity strengthening.

Through basic care and support services all TB/HIV patients will be put on co-trimoxazole prophylaxis

therapy (CPT) according to the national guidelines. Community health care providers will trace family

members of PLWHA accessing TB/HIV services and facilitate their TB screening and appropriate care. This

activity will be linked to activities in basic care and support through community and faith based

organizations (CBOs/FBOs) and home based care programs. TB/HIV treatment and care will be provided in

a comprehensive approach consistent with GON treatment guidelines and IMAI guidelines.

AR will ensure proper patient triage, specimen collection and processing, waste disposal, proper ventilation

and administrative control activities such as active identification of those with TB symptoms and patient

segregation. TB infection prevention and control will be accomplished using these workplace practices,

administrative and environmental measures. Patient and staff education will be routinely conducted to

ensure program success. AR will continue to use the joint adherence strategies for patients on ARVs and

TB DOTS and strengthen the facilities' capacity to meet special needs of PLWHA on both ART and anti-TB

treatment. Nosocomial transmission of TB to HIV+ patients as well as facility staff will be prevented through

measures and principles such as basic hygiene, proper sputum disposal, and good cross ventilation at

clinics. Facility co-location of TB/HIV services is preferred to clinic co-location. The national guidelines on

TB infection control on co-located sites will be implemented in all AR supported sites. Patients screened

and treated for TB and TB/HIV will be entered into the updated reporting tool provided by the NTBLCP with

appropriate linkages of medical records between TB and HIV points of service. In support of the NTBLCP

and STBLCP, AR will provide TB consumables, reporting & recording tools, ACSM materials in places

where these are not available.

AR will train 77 healthcare workers in the TB/HIV program. Medical records staff will be trained on data

collection for suspected and diagnosed TB cases. Healthcare providers will be trained on x-ray diagnosis,

clinical management, and care of TB/HIV co-infected patients which will be complemented by onsite

preceptorships and mentoring to enhance case finding. Community health workers, treatment support

specialists (including PLWHA), and members of Society of People Affected by TB (SOPAT) will be trained

to assist with patient adherence to ART and anti-TB drugs. AR will deploy 2 TB/HIV focal nurses and 1 TB

laboratory specialist to support the current 3 TB/HIV focal physicians and 1 TB laboratory specialist for the

management of this program especially in areas of community TB care (CBTC), DOTS Expansion MDR

surveillance, operational research and PPM DOTS. All AR TB staff will be trained/ retrained to enhance TB

diagnostic and management skills.

In COP09, AR will use its Quality Improvement Program (QIP) to improve and institutionalize quality

interventions. The existing 4 CQI specialists will continue to spearhead QIP activities in their respective

regions. This will include standardizing patient medical records to ensure proper record keeping and

continuity of care at all LPTFs. AR TB/HIV activities that will be addressed include program level reporting

to enhance the effectiveness and efficiency of both paper based and computer based Patient Monitoring

and Management (PMM) systems assuring data quality across all LPTFs. Using in-country networks and

available technology, AR will strengthen PMM system with added emphasis on harmonization with the

Government of Nigeria's (GoN) emerging National PMM system. AR's TB/HIV team will continue to work

with the AR QIP specialists to conduct formalized site visits at least quarterly during which there will be

evaluations of TB/HIV clinic services, TB laboratory services, infection control practices, utilization of

National PMM tools and guidelines, proper medical record keeping, patient follow-up and referral

coordination. On-site TA/supportive supervision with more frequent follow-up monitoring visits will be

provided to address weaknesses when identified during routine monitoring visits. Each of these activities

Activity Narrative: will highlight opportunities for improvement of clinical practices.

Sustainability lies at the heart of the AR program. AIDSRelief will continue the Sustainability Plan developed

in Year 4 focusing on technical, organizational, funding, policy and advocacy dimensions. Through its

comprehensive approach to programming, AR will increase access to quality care and treatment, while

simultaneously strengthening health facility systems. All activities will continue to be implemented in close

collaboration with the Government of Nigeria (GON) at both the State and Federal levels, to ensure

coordination and information sharing, thus promoting long-term sustainability. AR will continue to strengthen

the health systems of LPTFs. This will include human resource support and management, financial

management, infrastructure improvement, and strengthening of health management information systems. In

collaboration with the CRS SUN project, AR will focus on institutional capacity building for indigenous

umbrella organizations such as the Catholic Secretariat of Nigeria (CSN). These strategies will enable AR to

transfer knowledge, skills and responsibilities to in-country service providers.

CONTRIBUTIONS TO OVERALL PROGRAM AREA:

TB/HIV care through collaborative activities with NTBLCP will contribute to the GON's goal for appropriate

TB/HIV care. The co-location of TB DOTS centers in all AR supported LPTFs and HCT services in all AR

supported TB DOT sites will expand access to both quality TB services for HIV infected clients and HIV

services for TB Patients. This improved access will result in higher TB case detection and improved clinical

outcomes. The setting up of two state reference laboratories in collaboration with the respective state

governments will improve TB diagnosis among PLWHAs, increase access to TB culture in the country and

support the country program in MDR TB surveillance, diagnosis and management. The systematic

implementation of TB/HIV collaborative activities by AIDSRelief will contribute to Nigeria's 5-Year plan

which is expected to result in synergies to decrease TB prevalence rates.

LINK TO OTHER ACTIVITIES:

AR activities in TB/HIV are linked to HCT ARV services, ARV drugs, laboratory, care and support, PMTCT,

OVC, AB, and SI to ensure that TB/HIV patients have a continuum of services. This will be in collaboration

with the 7-Diocese program of CRS and other FBOs and CBOs. It will be linked to PMTCT to ensure that

HIV positive pregnant women are screened for TB, so that those dually infected are treated to reduce the

risk of transmission to the baby postpartum and to the community. This will also reduce the mother's

morbidity and mortality.

POPULATION BEING TARGETED:

The target population is all PLWHAs enrolled into the care and support program at LPTFs. In addition, TB

patients and suspects in supported DOTS centers are targeted. Household members of TB/HIV co-infected

patients will also be targeted as they are at increased risk of acquiring TB.

EMPHASIS AREAS

This activity has an emphasis on human capacity development through training to meet immediate

workforce requirements. Emphasis areas also include wraparound TB programs, renovations, quality

assurance, and development of linkages/referral and networks in collaboration with the STBLCP in support

of TB/HIV and TB DOTS programs. In addition, this activity will increase gender and age equity by ensuring

access to TB/HIV services for young women who account for 41% of TB cases in Nigeria and are about

60% of the PLWHAs screened for TB at LPTFs.

New/Continuing Activity: Continuing Activity

Continuing Activity: 12998

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

12998 5399.08 HHS/Health Catholic Relief 6365 3688.08 HHS/HRSA $870,000

Resources Services Track 2.0 CRS

Services AIDSRelief

Administration

6677 5399.07 HHS/Health Catholic Relief 4162 3688.07 Track 2.0 $1,033,750

Resources Services

Services

Administration

5399 5399.06 HHS/Health Catholic Relief 3688 3688.06 Track 1.0 $331,184

Resources Services

Services

Administration

Emphasis Areas

Health-related Wraparound Programs

* TB

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $60,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $40,000

and Service Delivery

Food and Nutrition: Commodities

Estimated amount of funding that is planned for Food and Nutrition: Commodities $20,000

Economic Strengthening

Education

Water

Table 3.3.12:

Funding for Care: Orphans and Vulnerable Children (HKID): $750,000

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

AIDSRelief (AR) has a family-centered approach for the care and treatment of people living with HIV/AIDS

(PLHA) and those affected by the epidemic, especially orphans and vulnerable children (OVC). In COP08,

AR reached 4,207 OVC through 31 Local Partner Treatment Facilities (LPTFs) and 10 satellite sites in 16

states (Abia, Adamawa, Anambra, Benue, Ebonyi, Edo, Enugu, FCT, Imo, Kaduna, Kano, Kogi, Nasarawa,

Ondo, Plateau and Taraba). In COP09, AR will work in a total of 34 LPTFs and 19 satellite sites in the same

states.

During COP09, a full package of OVC services will be provided to 4,000 OVC. All 4,000 children will

receive at least 3 core services from AR. In setting and achieving COP09 targets, consideration has been

given to modulating AR's rapid COP08 scale-up plans in order to concomitantly work towards continuous

quality improvement.

AR OVC programming has several key elements: proactively seeking children at risk through a multi

pronged approach for increasing access to HIV Counseling and Testing (HCT); providing a holistic family-

centered approach to care of OVC; providing nutritional assessment, nutritional demonstration activities and

support; ensuring adequate primary health care for OVC; and providing enhanced psychosocial support at

both the facility and community levels. AR will place significant emphasis on strengthening services to OVC

beginning with building skills in LPTF staff and community/home based care providers to identify children

who are vulnerable and providing them with appropriate services. Adequate health care will include

strengthening linkages and referrals to other facility services (maternal/child health, inpatient and outpatient

departments). Community based services will be strengthened to ensure referral to facilities for OVC

households through a family-centered opt-out approach to HCT services for all children <18 years of age

and their caregivers.

AR will adopt use of the Child Status Index to assess vulnerability and provide services. In collaboration

with Community Based Organizations (CBOs), Faith Based Organizations (FBOs) and other OVC

programs, particularly the Catholic Relief Services (CRS) SUN project, AR will ensure that OVCs receive

comprehensive care and support services with emphasis on decentralization of these services to the

community and home levels. All OVC households will also receive a preventive care package containing

ITN, water guard, water vessel, soap, ORS sachets, and Information Education and Communication

materials on self care and prevention of common infections according to Government of Nigeria (GoN)

guidelines. These services will be underpinned by providing good supportive counseling for children and

adolescents. AR will intensify collaboration with GON and other stakeholders to ensure prompt diagnosis of

tuberculosis (TB) in children and facilitate provision of pediatric TB formulations. To avoid double counting,

AR carries out joint quarterly monitoring of these activities using GON tools and OGAC OVC CSI.

All OVC and their households reached by the AR program will be assessed for the identification of specific

client/household needs and provided with psychosocial, nutritional, protection and health care supports

where necessary. The psychosocial support provided to OVC, including their caregivers, is multifaceted and

comprehensive and includes frequent home visits by facility trained community volunteer or volunteers from

the LPTFs for assessment of health status, counseling on stigma and discrimination, disclosure, and grief.

AR will strengthen existing structures to build kid support groups in all LPTFs and expand their activities to

include periodic social/recreational and educational activities with the involvement of uninfected children to

address issues of stigma and discrimination. AR will build capacity in the team and at the LPTF to establish

adolescent programs for infected and affected children.

AR will provide nutritional services including nutritional assessment and micronutrient supplementation to

approximately 1,000 OVC. AR will expand its central OVC team to include a nutritionist who will assist in

building capacity of HCW in nutritional assessment, establishing nutritional corners in all LPTFs for culturally

and regionally sensitive counseling rehabilitation. AR will strengthen collaboration with Clinton Foundation

for provision of therapeutic food supplements and also with other PEPFAR-supported organizations offering

food program for OVC such as the MARKETS activity and CRS 7 Dioceses (7D) in states where they are co

-located. In addition, AR will collaborate with NPI to ensure delivery free and appropriate immunization to all

OVC less than 5 years. AR will ensure birth registration for OVC and roll out of a child protection policy for

all our LPTFs in collaboration with appropriate GoN agencies and other CBOs. AR will also participate in

advocating the GoN at the state levels for welfare services for OVC (e.g., free primary education). Linkages

to CRS SUN, 7D and other CBOs will ensure the full provision of community and HBC services to OVC

clients.

AR will facilitate a summit for the review of and adoption of evidence based best practices in maternal and

child health for IPs and stakeholders in collaboration with the University of Maryland School of Medicine.

60 health care workers will be trained in COP09 using national guidelines and OVC standards of practice.

Specific training relevant to each level of HCW will be provided at each LPTF for at least one doctor, one

nurse and one counselor. AR will sustain training in pediatric counseling using the curriculum developed by

AR in partnership with the African Network for Children affected by HIV (ANECCA) to all LPTFs and other

stakeholders in Nigeria. Increasing the skills of providers will help meet the special needs of children and

their parents/caregivers and will provide the support needed at the family level by working with HBC

programs under the 7D and SUN programs of CRS. This curriculum will also be shared with the GON to

elicit endorsement of the materials and also the opportunity of the GoN to benefit from the materials.

In COP09, AR will strengthen its program for Continuous Quality Improvement (CQI) to improve and

institutionalize quality interventions. This will include standardizing patient medical records to ensure proper

record keeping and continuity of care between LPTFs and communities. Monitoring and evaluation of the

AIDSRelief OVC program will be consistent with the national plan for patient monitoring. AR CQI specialists

and OVC focal persons will conduct team site visits at least quarterly during which there will be evaluations

of OVC services provided, the utilization of National PMM tools and guidelines, proper medical record

keeping, referral coordination, and use of standard operating procedures by the HBC and facility providers.

On-site TA with more frequent follow-up monitoring visits will be provided to address weaknesses when

Activity Narrative: identified during routine monitoring visits. Each of these activities will highlight opportunities for

improvement of clinical practices.

Sustainability lies at the heart of the AR program, and is based on durable therapeutic programs and health

systems strengthening. AR will focus on the transition of the management of care and treatment activities to

indigenous organizations by actively using its extensive linkages with faith based groups and other key

stakeholders to develop a transition plan that is appropriate to the Nigerian context. The plan will be

designed to ensure the continuous delivery of quality HIV care and treatment, and all activities will continue

to be implemented in close collaboration with the Government of Nigeria to ensure coordination, information

sharing and long term sustainability. For the transition to be successful, sustainable institutional capacity

must be present within the indigenous organizations and LPTFs they support; therefore, AR will strengthen

the selected indigenous organizations according to their assessed needs, while continuing to strengthen the

health systems of the LPTFs. This capacity strengthening will include human resource support and

management, financial management, infrastructure improvement, and strengthening of health management

information systems.

CONTRIBUTION TO OVERALL PROGRAM AREA:

Scaling-up OVC services will contribute to the USG/ PEPFAR target of providing comprehensive quality of

care to 400,000 children infected and affected by HIV/AIDS in Nigeria. The OVC activity will contribute to

the AR overall comprehensive package of care for PLWHAs by ensuring that children's specific needs are

met. Training activities will contribute to overall program sustainability by building the knowledge and skill

base across all supported sites.

LINKS TO OTHER ACTIVITIES:

AR activities in OVC are linked to HCT, ARV services, PMTCT, ARV drugs, laboratory, AB, TB/HIV,

Pediatric care and treatment, and SI to ensure that OVC are provided a continuum of care. Linkages to

CRS SUN, 7D and other CBOs will ensure the full provision of community and HBC services to OVC clients.

POPULATION BEING TARGETED:

This activity targets infants, young children, adolescents and other at-risk children in HIV infected and

affected families. It also targets the households, including caregivers, of OVC. Health and allied care

providers in clinical and community settings will be trained to provide services to OVC.

EMPHASIS AREAS:

The activity has an emphasis on human capacity development through training and commodity

procurement. Other areas of emphasis include wraparound services (food, immunizations) and SI.

The activity will ensure gender and age equity in access to basic care and support and TB/HIV services to

both male and female OVCs in AR-supported LPTFs.

New/Continuing Activity: Continuing Activity

Continuing Activity: 12999

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

12999 5416.08 HHS/Health Catholic Relief 6365 3688.08 HHS/HRSA $945,000

Resources Services Track 2.0 CRS

Services AIDSRelief

Administration

6679 5416.07 HHS/Health Catholic Relief 4162 3688.07 Track 2.0 $288,000

Resources Services

Services

Administration

5416 5416.06 HHS/Health Catholic Relief 3688 3688.06 Track 1.0 $150,625

Resources Services

Services

Administration

Emphasis Areas

Health-related Wraparound Programs

* Child Survival Activities

* TB

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $60,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $60,000

and Service Delivery

Food and Nutrition: Commodities

Estimated amount of funding that is planned for Food and Nutrition: Commodities $60,000

Economic Strengthening

Education

Water

Table 3.3.13:

Funding for Testing: HIV Testing and Counseling (HVCT): $90,000

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

AIDSRelief (AR) will increase support for counseling and testing (HCT) services to a total of 84 sites. This

would comprise the current 31 Local Partner Treatment Facilities (LPTFs) and 10 satellite (in 16 states of

Abia, Adamawa, Anambra, Benue, Ebonyi, Edo, Enugu, FCT, Imo, Kaduna, Kano, Kogi, Nasarrawa, Ondo,

Plateau, and Taraba) and to an additional 3 LPTFs, 9 satellite sites in COP09 in the 16 states. HCT

services will also continue at the 31 TB DOT sites supported by AIDSRelief. An emphasis will be placed on

satellite decentralization clinics and family members of in care clients. 9,000 persons will benefit from HCT

and receive their results. This includes 8,100 adults and 900 pediatric clients. AR will build the capacity at

existing and new LPTFs to enable them to integrate HCT services within care and treatment systems. In

COP09 the AR HCT site and community level activities will stress: (1) providing technical assistance,

particularly in identifying most at risk persons in need of HCT, and (2) working with sites to identify and

obtain additional resources (from the GON, other donors, Global Fund, etc.) to provide commodities and

increase uptake of HCT services in all points of service in the facilities.

All HCT service outlets will continue to be branded with the "Heart to Heart" logo. AR will continue to

encourage Provider Initiated Testing and Counseling (PITC) and point of service testing started in COP08 in

all supported healthcare facilities. This approach to HCT will be actualized by AR technical and

programmatic staff through onsite mentoring/preceptorship of providers and the engagement of leadership

at AR-supported facilities. AR will also scale-up couples counseling and testing in all supported sites

through organized training, family centered testing and on- site mentorship. AR will promote HCT as a

necessary and important arm of HIV prevention in terms of averting new infections and providing treatment

for those in need, and post-test counseling will be strengthened to lay emphasis on prevention for positives.

Post test counseling will include full and accurate information on all prevention strategies. Referrals to

outlets that provide other prevention services not available at AR-supported facilities will be provided.

All HCT sites will provide same day results and will use the current National serial testing algorithm. For

infants and children less than 18 months, Early Infant Diagnosis (EID) will be available at PMTCT sites

according to the national scale up plan; lab testing for EID will be done in conjunction with other IPs. The

USG will provide AR with rapid HIV test kits and AR will be responsible for their warehousing, storage and

distribution to LPTFs. Sites will be actively linked to the Government of Nigeria and other donor agencies to

access extra kits and supplies needed, and supported to maintain their regular usage and feedback through

the above mentioned strategies. Sites will be trained on forecasting and stock control using bin cards and

will maintain a three month buffer stock. LPTFs will report on inventory and forecasting to the AIDSRelief

central office on a monthly basis.

In COP09, AR will target the provision of HCT services mainly to People Affected by HIV/AIDS (PABAs) -

especially children, as well as to STI patients and TB DOT clients at the LPTFs and satellite clinics. At rural

satellite clinics, AR will also target women of reproductive age with combined HCT and STI screening. AR

will also provide HCT services at blood transfusion points of service, following the multiple points of service

model for facility based HCT. All HCT clients will be linked to prevention services, as well as treatment, care

and support services where applicable.

AR will train 30 LPTF staff on counseling and testing using the GON HCT training curriculum. Counselor

training will include couples counseling to strengthen this aspect of the program. This will ensure the

availability of a pool of trained counselors to promote continuity. In addition, providers will be sensitized on

the adoption of PITC and point of service testing in their facilities. Non-laboratorians will be used at multiple

points of service for facility based HCT where appropriate and when allowed by national policy. To this

effect AR will train HCW (counselors, nurses and outreach workers) that will be supervised by onsite

laboratorians to assure quality. To expand HCT services within the network of faith based organizations and

increase rural access to HCT, AR community based HCT will advocate for greater use of non-laboratory

staff to conduct testing in the community setting as well.

AR will carry out quarterly monitoring visits which focus on quality assurance and onsite mentoring. There

will be evaluations of counseling techniques, HCT testing algorithms, the utilization of the National CT

Register, proper medical record keeping, referral coordination, patient flow, and use of National HCT tools.

On-site TA with more frequent follow-up monitoring visits will be provided to address weaknesses when

identified during routine monitoring visits. Semi-annual subpartner meetings will provide an additional forum

for sharing of new information between sites and communities.

AIDSRelief will collaborate with faith based and community based organizations, in particular the 7-

Dioceses program of Catholic Relief Services, in carrying out community based and mobile HCT services.

AR will also collaborate with state and local government HCT programs by carrying out joint trainings,

monitoring visits and leveraging resources to test those who may require testing outside the USG supported

numbers.

CONTRIBUTIONS TO OVERALL PROGRAM AREA:

AIDSRelief will provide HCT services at 84 sites at the primary and secondary levels in rural and previously

underserved communities to provide services to 9,000 clients including 900 children thus contributing to the

PEPFAR and GON targets for increasing access to HIV counseling and testing. HCT services will enable

the identification of HIV positive individuals in a timely manner and will direct them into care and treatment

services. HCT will add to the prevention strategies of averting new infections through efficient and effective

posttest counseling and patient education. HCT will further contribute to the National goal of universal

access to HIV/AIDS services. By building LPTF capacity through training, salary support to faith based

institutions and refitting of LPTF counseling rooms, AR will contribute to the sustainability of HCT activities

at these sites and in Nigeria.

LINKS TO OTHER ACTIVITIES:

This activity relates to activities in care and treatment (adult and pediatric), laboratory, PMTCT, OVC, AB,

TB/HIV and SI. Linkage of HCT to care and treatment services shall be strengthened within and across

Activity Narrative: programs and between other implementing partners using standard referral tools. AR will establish referral

linkages with National TB DOTs centers to ensure that TB patients are routinely screened for HIV and those

testing HIV+ are referred to AR LPTFs for HIV/AIDS care and treatment. The LPTFs will ensure integration

of the AR-supported HCT program with other departments to provide routine HCT services to all patients

and to ensure that those testing HIV+ are referred for appropriate care.

POPULATIONS BEING TARGETED:

This activity targets particular PABAs (especially children), STI patients, and TB suspects/patients in the

general population.

EMPHASIS AREAS

This activity has emphasis on training, including supportive supervision and quality assurance/quality

improvement. There is an additional emphasis on local organization capacity building, community

mobilization, infrastructure development/renovation, and the development of linkages/referral systems.

The expansion of free HCT services will ensure gender equity in access to HCT services in rural and

previously underserved communities. It will also ensure that HIV-positive people are identified and linked to

timely life-saving ART services and HIV-negative clients are educated on the importance of avoiding risky

behaviors.

New/Continuing Activity: Continuing Activity

Continuing Activity: 13000

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

13000 5425.08 HHS/Health Catholic Relief 6365 3688.08 HHS/HRSA $980,000

Resources Services Track 2.0 CRS

Services AIDSRelief

Administration

6681 5425.07 HHS/Health Catholic Relief 4162 3688.07 Track 2.0 $1,025,000

Resources Services

Services

Administration

5425 5425.06 HHS/Health Catholic Relief 3688 3688.06 Track 1.0 $240,000

Resources Services

Services

Administration

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $20,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.14:

Funding for Treatment: ARV Drugs (HTXD): $7,012,776

ACTIVITY MODIFIED AS FOLLOWS:

In COP09, AIDS Relief (AR) will procure anti-retroviral (ARV) drugs so that ARV treatment can be provided

to 33,450 patients including 30,150 adults and 3,300 children at 34 Local Partner Treatment Facilities

(LPTFs) and 19 satellite clinics in 16 states of Abia, Adamawa, Anambra, Benue, Ebonyi, Edo, Enugu, FCT,

Imo, Kaduna, Kano, Kogi, Nasarawa, Ondo, Plateau, and Taraba. In COP09 AR will open 3 new LPTFs and

9 satellite clinics to broaden access to the ARV Drugs. In setting and achieving COP09 targets,

consideration has been given to modulating AR's rapid COP08 scale up activities in order to concomitantly

work towards continuous quality improvement.

AR's supply chain management system will ensure that the necessary infrastructure, systems and skills are

in place for efficient forecasting, procurement, storage, and distribution of quality anti-retrovirals (ARVs) to

AR-supported LPTFs. Assessment of new sites will follow the AR Information Gathering Tool and the

Pharmacy Support and Assessment Standards Checklist. Pharmacies will be refitted to improve commodity

security. Technical support to LPTFs to institutionalize standard operating procedures (SOPs) for drug

management will continue in COP09. AR will train and retrain 40 pharmacists and 50 other health workers

including pharmacy technicians or assistants in the use of developed standard operating procedures

(SOPs) that are in line with national guidelines. These SOPs include drug requests, receipts, recording,

dispensing, discrepancy reporting, temperature control and disposal of expired drugs. In-depth training of

the LPTF staff in the utilization of SOPs, forecasting and quantification for ARVs and general drug

management issues will be conducted.

AR annual forecasting exercise was done in conjunction with the USG Logistics Technical Working Group

and SCMS in August 2008. Based on the projections, AR is moving towards a predominantly Tenofovir-

based first line regimen in accordance with National Treatment Guidelines. An estimated 25% of people

living with HIV/AIDS (PLWHA) already enrolled in care will qualify for and be placed on ART during the

year. According to projections, 5% of the patients are expected to be on second line ARV regimens. The

use of pediatric Fixed Dose Combinations (FDC) will be stepped up in COP 09.

Procurement procedures will follow USG, FDA and National Agency for Food and Drugs and Control

(NAFDAC) regulations. NAFDAC importation waivers are secured through the USG for unregistered drugs.

All ARVs are procured from Good Manufacturing Practice certified sources which are FDA approved/pre-

approved. Generic batches are tested by an independent laboratory (VIMTA Laboratories) in India or Center

for Quality Assurance of Medicines (CENQAM), North West University, South Africa for compliance with all

requirements before shipping. They are warehoused and transported under air-conditioned environments in

-country and have in-transit insurance coverage. IDA Foundation and Phillips Pharmaceuticals are

contracted for procurement and CHAN Medi-Pharm for warehousing and distribution. AR will substitute

innovator proprietary ARVs with FDA approved generic equivalents taking into consideration issues of

safety, quality and cost. All purchases of Truvada (TDF/FTC) and ZDV-3TC-NVP Fixed Dose will be

purchased via SCMS pooled procurement mechanism in line with OGAC's recommendation.

The Pharmaceutical Management Team manages country operations with a Therapeutic Drug Committee

(TDC) comprising of clinicians, pharmacists, palliative care specialists, strategic information advisors and

program managers. The TDC reviews drug utilization patterns across all LPTFs, assesses scale-up

progress and develops required technical support plans. AR will support the strengthening or establishment

of Therapeutics Drug Committees (TDC) at all Local Partner Treatment Facilities. The TDC will have the

key responsibility of developing policies for managing medicines use and administration, evaluating the

clinical use of drugs and managing a formulary system. The TDC will promote rational use of medicines

(RUM) through the medication use reviews, provision of drug information to patients, monitoring medication

errors, development and implementation of pharmacovigilance plans and development and implementation

of continuing education plans. The AR technical team will provide technical assistance through training and

on site mentorship for these committees. Technical assistance will be provided to the LPTFs in

development and implementation of Pharmacovigilance plan (data gathering activities relating to detection,

assessment and understanding of adverse drug events/reactions i.e. Adverse Drug Effects or Adverse Drug

Reactions and treatment failure). The TDC is replicated at the LPTF level to ensure that the ARV supply

chain management is clinically informed and logistically supported. Quality assurance covers the entire

spectrum from procurement to dispensing. All sites will be provided with ongoing TA by AR's Health Supply

chain technical team. Pharmacy and logistics management procedures will be assessed and will be part of

site development planning. The Logistics Management Information System (LMIS) will include an inventory

tracking tool that allows drug tracking from procurement to dispensing and interfaces with the ART

Dispensing Software developed by Management Sciences for Health installed at LPTFs. AR will participate

in the ongoing harmonization of the national LMIS system.

AR will continue to work with the Government of Nigeria, Clinton Foundation (Pediatric ARVs and Second-

line Adult ARVs) and other stakeholders to leverage resources for ARVs.

CONTRIBUTION TO OVERALL PROGRAM AREA:

The ARV drug activity will ensure that quality ARVs are supplied to all patients in a timely manner.

Appropriate product selection and forecasting will ensure the effective use of scarce resources. By scaling

out ARV drug services to 3 new LPTFs and 9 satellite clinics in COP09 (mostly rural based primary and

secondary faith based facilities), AR will contribute towards the National and PEPFAR plans of increasing

access to ARV drugs in previously underserved communities. As expansion of ARV drug services is

prioritized to rural areas, AR will strengthen existing referral channels and will support network coordinating

mechanisms. By providing ARV drug services to 33,110 clients, the activity will contribute to the PEPFAR

target of providing ARV drugs to 350,000 PLWHAs in Nigeria by 2009 as well as to the Government of

Nigeria's (GON) plan for universal access to ARV drugs by 2010.

LINKS TO OTHER ACTIVITIES:

This activity relates to activities in ARV services, laboratory, care and support, PMTCT, and SI.

New/Continuing Activity: Continuing Activity

Continuing Activity: 13001

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

13001 9889.08 HHS/Health Catholic Relief 6365 3688.08 HHS/HRSA $8,535,519

Resources Services Track 2.0 CRS

Services AIDSRelief

Administration

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $90,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.15:

Funding for Laboratory Infrastructure (HLAB): $3,297,121

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

This activity ensures that appropriate lab support is provided for HIV clinical monitoring and HIV testing.

Linkages with Strategic Information (HVSI) will ensure tracking of lab infrastructure indicators. AIDSRelief

(AR) works in tertiary and secondary health care facilities to provide quality HIV/AIDS services to people

living with HIV and AIDS (PLWHAs). AR supports Laboratory (Lab) infrastructure for all of our local partner

treatment facilities (LPTFs).

AR provides on-site capacity for HIV testing, laboratory monitoring of disease progression and response to

treatment, diagnosis of opportunistic infections (OIs), and monitoring of antiretroviral drug (ARVs) toxicity.

AR will support the improved diagnosis of TB, PCP, cryptococcal infection, syphilis, hepatitis B (HBV),

protozoal and bacterial infections. AR does not routinely do Viral load (VL) testing but ensures that VL

testing is performed to make difficult therapy switch decisions as well as to evaluate the program. A random

10% subset of clients from each LPTF who have been on therapy for a period of 6 -9 months is tested

annually through collaboration with other PEPFAR IPs with viral load capacity and at 2 of our LPTFs with VL

testing capacity. In addition, 2-3% of AR clients on ART will require VL testing based on clinical indications

AR will also continue to support expansion of early infant diagnosis (EID) at PMTCT-supported facilities in

accordance with the national EID scale up plan. AR, with support from the Clinton Foundation, will provide

standardized training and supplies for collection and transport of dried blood spots (DBS) to DNA PCR

testing laboratories and return of results to clinics.

AR will continue to participate in the USG-Nigeria coordinated Laboratory Technical Working Group (LTWG)

to ensure harmonization with other IPs and GoN-supported laboratory programs. AIDSRelief will continue to

work with the PEPFAR LTWG towards the development of a common Lab equipment platform appropriate

for each lab level.

In COP08, AIDSRelief is providing support to 30 sites in a total of 16 states (Abia, Adamawa, Anambra,

Benue, Ebonyi, Edo, Enugu, FCT, Imo, Kaduna, Kano, Kogi, Nasarawa, Ondo, Plateau, and Taraba). Of

these 30 sites, 28 are secondary level and 2 are tertiary level. Two of these facilities have PCR capacity: 1)

St Vincent's DOC (DREAM model) has bDNA VL testing supported by CRS private funding and 2)

Annunciation Specialist Hospital in Enugu has NucliSens VL machine (initiated prior to PEPFAR). AR will

continue providing automated CD4 testing equipment with capacity for processing large patient loads

cytosphere reagents using binocular microscopes that are easy to use and appropriate for secondary care

centers for manual CD4 testing as backup in place of automated CD4, hematology analyzers and chemistry

machines. All labs will be supported to test for syphilis, PCP, TB, HBV, hematology, chemistry,

cryptococcosis, and CD4 count.

In COP08, AR provided 10 LPTFs with fluorescent microscopes to enhance TB and malaria diagnostic

capacity at high volume sites. In COP09, AR will provide an additional 5 LPTFs with fluorescent

microscopes and support necessary training and reagent procurement for these equipment at all 15 labs.

In addition to 10 primary level satellites activated in COP08, 9 new satellite sites will have a laboratory

capacity for hematology, CD4 and HIV rapid testing and positive patients will be referred to the parent site

for ART. In setting COP09 targets and expansion, consideration has been given to modulating AR's rapid

COP08 scale up plans in order to concomitantly work towards continuous quality improvement.

In COP09, AR will continue to improve lab equipment sourcing locally and lab equipment maintenance at

our secondary and tertiary LPTFs. To this end some of the lab equipment will be centrally procured and

shipped to Nigeria and some will be sourced locally using reputable vendors. An AR in-country lab specialist

will be dedicated to overall equipment installation and maintenance. All AR lab specialists have received

training and will continue to receive updated trainings from CD4 manufacturers and other lab equipment

manufacturers as maintenance engineers to support the servicing of CD4 and other machines. 10% of the

cost of all equipment will be kept in reserve for maintenance purposes. AR-supported lab engineers at 6

supported LPTFs will be included in these trainings and used as trainers, mentors and engineers, along with

AR Lab specialists for other AR-supported labs, where appropriate, as an approach to sustainability. AR will

build the capacity of 2 LPTF regional labs already supported (Evangel Hospital Jos and Annunciation

Hospital, Enugu), by training biotech engineers as equipment repairs/maintenance engineers and

technicians. This will be done in collaboration with the equipment manufacturers and vendors.

In COP08, AR developed a comprehensive lab program with 9 locally based FTE lab specialists focused in

the following areas: 1 centrally based lab program director, 1 equipment installation/trouble shooting, 3 site

quality monitoring, 1 blood / injection safety, 1 TB lab and 2 training. These will be supported by a Baltimore

-based lab specialist. AR will deploy 2 Lab specialists who will be dedicated to lab commodity management

and quality monitoring respectively.

AR will use its reagent forecasting tools at all levels to determine consumption and predict need, to forestall

stock outs. Working with SCMS and CHANPharm, AR will centrally procure lab reagents from

manufacturers locally and abroad and distribute to LPTFs. HIV Test kits will be provided directly by the USG

through the SCMS mechanism.

AR will work with locally certified QA experts to implement the Lab external quality assurance (EQA)

program, and work with UMD-ACTION for back-up CD4 testing support, training support for EID/DBS and

provision of specialized Lab tests such as VL and DNA-PCR. To support pediatric diagnostic and treatment,

Clinton Foundation will provide DBS collection material and transportation of specimens/results. AR will

work with JSI/MMIS to provide blood safety training and other safety materials to all sites.

To ensure safety in the lab, AR will increase its provision of appropriate sharps and bio-medical waste

disposal containers at all sites. In COP08, AR supplied biosafety containers to 10 of its LPTF labs to ensure

a safe work environment during AFB method of TB diagnosis. In COP09 AR will extend provision of the

same to all remaining LPTFs. AR will ensure the availability of functional incinerators and/or collection of

biomedical waste by approved, private companies. AR will also support and provide post HIV exposure

Activity Narrative: programs (PEP) at all sites.

In COP08, AR is working with MLSCN to gain local accreditation for 10 labs. This will include 2 tertiary and

8 secondary sites across 5 states. In COP09, AR will work with 5 additional laboratories to gain an initial

accreditation.

In COP08, AR worked with IHVN-ACTION tertiary lab specialists to train 90 lab personnel from all LPTFs in

the following areas: HIV diagnostics, CD4, chemistry, hematology and OI diagnosis. AR emphasizes hands-

on training during laboratory start up in lab techniques, lab management, simple equipment maintenance

and QA technique applicable to each level of laboratory. Refresher trainings are done at monthly intervals

and periodically as per identified needs at each of the older LPTF. AR provides simplified bench aids & lab

manuals to reinforce each training episode. AR will use the PEPFAR/Nigeria harmonized Training Manuals

to supplement the simplified manual from IHVN-UMSOM-University of Maryland. In COP09, in addition to

other activities AR will train selected LPTF personnel in equipment maintenance.

In COP09, AR will continue to conduct QA activities consisting of quarterly site monitoring visits (using a

standardized tool developed by the PEPFAR LTWG), quarterly proficiency testing (PT) for all tests and

reporting of these results into a centralized system. AR will sub-contract to locally certified QA experts to

implement the PT aspect of the EQA Program. They will offer trainings to AR Lab specialists in the act of

panel preparation, lab audits, and interpretation of EQA results and implementation of corrective actions.

In COP08, AR lab personnel participated in the training of trainers (TOT) lab management program

provided by Association of Public Health Labs (APHL), with support from PEPFAR/Nigeria. Knowledge

gained will be transferred to all LPTF lab personnel using the provided training materials. In COP09, AR will

organize 2 regional trainings on lab management for all heads of LPTF labs that AR supports.

CONTRIBUTIONS TO OVERALL PROGRAM AREA:

By supporting Lab infrastructure AR will help all LPTFs carry out 182,738 tests. The activity will also

contribute to AIDSRelief's target of providing quality ART services to 33,450 clients including 3,300 pediatric

patients in COP09. This activity will also contribute to the reduction in Mother to child transmission of HIV

and early detection of any infant HIV infection. The activity will further contribute to the reduction and early

detection of any treatment failures among our clients by providing VL tests for a subset of the 33,450 ART

clients in COP09. This will support the possible need for ARV regimen switch for patients failing on first line

regimens. The activity will also provide infrastructure and training for TB diagnosis for the 50,000 clients in

care at the 34 LPTFs and will contribute to the overall program sustainability by improving Lab infrastructure

and by building capacity among primary and secondary level facilities.

LINKS TO OTHER ACTIVITIES:

AR activities in adult basic care and support are linked to HCT, Blood Safety, Injection Safety, ARV

services, PMTCT, ARV drugs, OVC, AB, TB/HIV, and SI to ensure that appropriate Lab support is provided

for lab diagnosis, clinical monitoring and HIV testing. AR will collaborate with IHVN-ACTION, other

implementing partners and state hospitals to optimize resources and strengthen the comprehensive

networks of care across the 16 states including centralized lab training, establishment of high level

laboratory services for VL testing and EID. AR will link LPTFs with local and PEPFAR procurement and

distribution agents such as CHANPharm and SCMS to ensure a sustainable supply chain for lab reagents.

AR regional program managers will act as network coordinators.

New/Continuing Activity: Continuing Activity

Continuing Activity: 13003

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

13003 6680.08 HHS/Health Catholic Relief 6365 3688.08 HHS/HRSA $3,726,342

Resources Services Track 2.0 CRS

Services AIDSRelief

Administration

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $90,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.16:

Funding for Strategic Information (HVSI): $750,000

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

In COP08, AIDSRelief provided strategic information (SI) management services to 31 local partner

treatment facilities (LPTFs), 10 satellite clinics and 31 TB DOTS stand-alone sites in 16 states (Abia,

Adamawa, Anambra, Benue, Ebonyi, Edo, Enugu, FCT, Imo, Kaduna, Kano, Kogi, Nasarawa, Ondo,

Plateau, and Taraba). In COP09 AIDSReliefR will continue to support these facilities and further expand

services to an additional 3 LPTFs and 9 satellites in the aforementioned states. In setting and achieving

COP09 targets across all program areas, consideration has been given to modulating AIDSRelief's rapid

scale-out plans in order to concomitantly work towards continuous quality improvement in SI activities.

AIDSRelief's SI activity incorporates program level reporting and implementation of both paper-based and

computerized Health Management Information Systems (HMIS) for AIDSRelief LPTFs. This activity is

coordinated by Constella Futures, one of AIDSRelief's consortium members. Using in-country networks and

available technology, AIDSRelief has continued to strengthen LPTFs' Patient Management Monitoring

(PMM) systems with added emphasis on harmonization with the Government of Nigeria's (GON) emerging

National PMM system in COP08. As part of capacity building and contribution to program sustainability

AIDSRelief has continued to provide logistical support for automated PMM to local partner facilities by

providing them with computers and other logistical support systems and will continue to expansion of these

services in COP09. Support has also been provided in COP08 for the pilot process of GON's Logistics and

Health Program Management Information Platform (LHPMIP) developed by Voxiva at AIDSRelief partner

and other facilities. AIDSRelief has already initiated the process of harmonizing its existing IQCare PMM

system with the LHPMIP with a view to actualizing efficient PMM-PME integration.

Throughout COP08, AIDSRelief has continued to strengthen its program for Continuous Quality

Improvement (CQI) in order to improve and institutionalize quality interventions. This has included

standardizing patient medical records to ensure proper record keeping and continuity of care at all LPTFs.

In COP09 AIDSRelief will continue to provide TA to LPTFs and personnel to adapt and harmonize existing

tools to meet the standards of the GON having conducted proper roll-out of GON's revised M&E tools thus

ensuring that monitoring and evaluation of the AIDSRelief program is consistent with the national plan for

patient monitoring. AIDSRelief's SI team has worked with the AIDSRelief CQI specialists to conduct site

visits at least quarterly during which evaluations of the utilization of National tools and guidelines, proper

medical record keeping, efficiency of clinic services and referral coordination were conducted. Data flow

including data collection, management and reporting was assessed and recommendations for improvement

given. Supportive supervision and mentoring has been provided to all on-site staff that collect and utilize

data (e.g., clinicians, pharmacists, data entry personnel, administrators). All of these activities will continue

to be supported in COP09 with more frequent on-site TA and follow-up monitoring visits to address any

weaknesses identified during routine monitoring visits.

A total of 120 LPTF personnel (including but not limited to data entry personnel, clinicians, nurses,

pharmacists, and administrators) will be trained in PMM to ensure that all health workers coming into

contact with patient records use them appropriately. State M&E officers shall be informed of, and involved in

the monitoring processes and the training programs in order to instill a sense of ownership and ensure

sustainability of these efforts. This strategy is in line with the USG SI data quality assessment/ improvement

(DQA/I) and capacity building plan. Information sharing and feedback from periodic (monthly and quarterly)

reports instituted in COP08 shall be continued in COP09 involving all LPTFs and respective state and local

government action committeesagencies onfor AIDS control (SACAs and LACAs) for their planning

purposes. In COP08, AIDSRelief entered into an agreement with MEASURE Evaluation to assist in training

and provision of TA for Data Demand and Information Use (DDIU) at selected AIDSRelief LPTFs. In

COP09, the DDIU trainings will be expanded to cover all local partner facilities as well as respective SACAs

and LACAs. A total of 84 of local organizations will be provided with technical assistance for strategic

information activities in COP09.

AIDSRelief SI team will continue to be active participants on the SI working group established and

coordinated by USG-Nigeria as well as the GON's National M&E Technical Working Group and its sub-

committees. In COP08 AIDSRelief actively participated in the pilot process for HIVQual and its phased roll

out at selected LPTFs. Due to the limitations of the CAREWare software that has been in use by AIDSRelief

across the 9 countries, the process of transitioning to IQCare with successful migration of all CAREWare

databases to the new software which provides for a more robust open source, freeware solution was

concluded in early COP08. IQCare will continue to be supported, developed and enhanced in AIDSRelief

partner facilities. Additionally, AIDSRelief will continue pursuing the harmonization process of its IQCare

application with the National Public Health online real-time data system (LHPMIP) as well as HIVQual.

Other activities being implemented at the site level is the use of IQCare queries for custom reports and Life

Table Analysis (LTA). LPTF staff have been trained and continuous TA is being provided to enable them

utilize the information in their IQCare databases to produce these custom reports. The LTA enables

utilization of publicly-available software to assist LPTFs to analyze and interpret their patient data using

simple procedures and recognized statistics. These procedures compute program continuation rates from

existing medical records maintained by the ART program. AIDSRelief has been training LPTF personnel

and will continue to provide TA in COP09 to enable them to continue to conduct these LTAs and custom

reports independently and thus contribute to the sustainability of this activity.

CONTRIBUTIONS TO OVERALL PROGRAM AREA:

Improvement in SI management capacity of existing and new LPTFs will instill a data use culture that leads

to improved quality of care. Staff training across the AIDSRelief sites in 16 states will contribute to overall

program capacity building and sustainability. The provision of logistics for automated PMM will contribute

towards the GON and USG strategy on provision of quality and timely data for decision making.

LINKS TO OTHER ACTIVITIES:

Since all programs require a robust data management system and data quality checks to ensure effective

programming, this activity relates to all AIDSRelief HIV/AIDS activities ARV services (6678.09), ARV drugs

(9889.09), laboratory (6680.09), care and support (5368.09), PMTCT (6485.09), OVC (5416.09), AB

(15655.09), TB/HIV (5399.09), Blood Safety (HMBL; HMIN; CIRC; IDUP) and Injection Safety.

Activity Narrative: POPULATIONS BEING TARGETED:

The AIDSRelief SI activity targets AIDSRelief LPTF personnel including those primarily engaged in SI

activities (on-site project coordinators, on-site M&E officers, data entrants, and medical records

technicians), other health care workers (physicians, nurses, counselors, pharmacy and laboratory staff) and

decision-makers (at LPTF, program and Government levels). This is to ensure that all personnel coming in

contact with the patient keep appropriate records and manage them efficiently and effectively with the data

thus gathered playing a major part in evidenced-based decision making at all levels.

EMPHASIS AREAS:

This activity has a major emphasis on strategic information (HMIS development) and reporting for program

level M&E with emphasis on targeted evaluations, logistics and training.

New/Continuing Activity: Continuing Activity

Continuing Activity: 13004

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

13004 5359.08 HHS/Health Catholic Relief 6365 3688.08 HHS/HRSA $1,100,000

Resources Services Track 2.0 CRS

Services AIDSRelief

Administration

6674 5359.07 HHS/Health Catholic Relief 4162 3688.07 Track 2.0 $400,000

Resources Services

Services

Administration

5359 5359.06 HHS/Health Catholic Relief 3688 3688.06 Track 1.0 $365,917

Resources Services

Services

Administration

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $120,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.17:

Subpartners Total: $17,896,878
Faith Alive Foundation Hospital: $800,000
Al Noury Hospital: $323,206
St. Vincent de Paul Hospital, Kubwa: $100,000
Ahmadiyyah Hospital: $268,016
Grimard Catholic Hospital: $100,000
Holy Rosary Hospital, Onitsha: $100,000
St. Camillus Hospital, Uromi: $100,000
St. Gerard's Hospital, Kaduna: $660,000
St. Louis Hospital, Zonkwa: $100,000
St. Vincent's Hospital, Aliade: $100,000
Our Lady of Lourdes Hospital, Ihiala: $100,000
Faith Mediplex: $187,880
Evangel Hospital: $727,288
Plateau State Specialist Hospital: $604,501
Institute of Human Virology, Nigeria: $9,000,000
Palladium Group (formerly Futures Group): $1,000,000
Bishop Murray Medical Center: $295,987
St. Monica Hospital, Adikpo: $100,000
St. Anthony Catholic Hospital: $100,000
St. John's Catholic Hospital, Kabba: $100,000
Community Support and Development Services Inc.: $20,000
St. Catherine's Hospital: $100,000
Evangelic Reform Church of Christ Alushi: $100,000
Comprehensive Health Center: $20,000
Nigeria Christian Hospital: $100,000
Holy Rosary Hospital, Emekuku: $100,000
General Hospital, Ikin: $20,000
Joint Hospital: $50,000
Mater Misericordiae Hospital: $100,000
Mbano Joint Hospital: $20,000
Medical Mission of Mary: $20,000
Mission Hospital Umunze: $20,000
Nsukka Health Center: $20,000
Our Lady Health of the Sick Hospital: $20,000
Sabon Sarki PHC: $20,000
St. Maria Catholic Hospita: $20,000
St. Joseph's Catholic Hospital, Ohabiam: $20,000
St. Martin's Ugwuagba, Obosi, Anambra: $50,000
St. Louis Hospital, Owo: $50,000
St. Joseph Hospital, Adazi: $100,000
St. Damian's Hospital, Okporo, Orlu: $20,000
Sudan Mission Hospital Onuenyim: $20,000
Tuberculosis and Leprosy Referral Hospital, Uzuakoli: $20,000
Tuberculosis and Leprocy Clinic, Akwa: $20,000
Annunciation Specialist Hospital: $270,000
Catholic Church (Various Dioceses): $20,000
Cottage Hospital : $20,000
Daughters of Divine Love Hospital: $50,000
DHU Ogaminana Okene: $20,000
Ebonyi State University: $100,000
Evangelical Church of West Africa: $20,000
Evangelical Church of West Africa: $20,000
Enugu State University: $100,000
Gembu Center for AIDS Advocacy Nigeria: $100,000
General Hospital, Tudun: $20,000
General Hospital, Akwanga: $20,000
General Hospital, Bambur: $20,000
General Hospital, Garkida: $20,000
General Hospital, Igueben: $20,000
General Hospital, Kauru: $20,000
General Hospital, Tse-Agbragba: $20,000
General Hospital, Wamba: $20,000
Health Center Obollo Affor: $20,000
Health Center Osisioma Abia: $20,000
To Be Determined: NA
Holy Rosary Hospital : $20,000
Ika Mission Hospital: $20,000
Immaculate Heart Hospital and Maternity: $50,000
Immaculate Heart Hospital and Maternity: $50,000
Mission Hospital PHC: $20,000
Mission Hospital Ebenebe: $20,000
Mother of Christ Hospital Specialist: $100,000
Our Lady of Apostles, Akwanga: $100,000
Primary Health Center, Dogon Kurumi Kaduna: $20,000
Primary Health Center, Isa Kaduna: $20,000
Primary Health Care Centre, Kwall, Bassa: $20,000
Primary Health Care Centre, Tundun Wada: $20,000
Primary Health Care Centre, Filin Bali: $20,000
Rural Health Center Owukpa: $20,000
Shuwa Health Center and Maternity: $20,000
St. Francis Jambutu Hospital, Yola: $100,000
St. Joseph Hospital, Ogobia: $20,000
To Be Determined: NA
St. Mary's Hospital, Orsumughu: $50,000
St. Mary's Hospital: $100,000
Mile 4 Catholic Hospital: $100,000
St. Thomas Hospital, Ihugh: $100,000
Thomas Clinic and Maternity Kipwe Lissam: $20,000
Visitation Hospital, Umuchu: $50,000
Cross Cutting Budget Categories and Known Amounts Total: $1,437,134
Human Resources for Health $180,000
Food and Nutrition: Policy, Tools, and Service Delivery $20,000
Human Resources for Health $60,000
Human Resources for Health $3,000
Human Resources for Health $90,000
Food and Nutrition: Policy, Tools, and Service Delivery $25,000
Food and Nutrition: Commodities $25,000
Water $25,000
Human Resources for Health $120,000
Water $89,134
Human Resources for Health $60,000
Food and Nutrition: Policy, Tools, and Service Delivery $20,000
Food and Nutrition: Commodities $10,000
Human Resources for Health $60,000
Food and Nutrition: Policy, Tools, and Service Delivery $20,000
Food and Nutrition: Commodities $10,000
Human Resources for Health $60,000
Food and Nutrition: Policy, Tools, and Service Delivery $40,000
Food and Nutrition: Commodities $20,000
Human Resources for Health $60,000
Food and Nutrition: Policy, Tools, and Service Delivery $60,000
Food and Nutrition: Commodities $60,000
Human Resources for Health $20,000
Human Resources for Health $90,000
Human Resources for Health $90,000
Human Resources for Health $120,000